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Get a Library Card

Application for a Library Card

Please fill out this form completely and click on the "Submit Application" button.
Your Library Card will be mailed to you at the address indicated.

NOTE: Only individuals who either live or work in Port Washington are eligible to receive a library card.

Today's Date
Name
Address
City, State & Zip
Date of Birth (mm/dd/yy) PHONE
E-mail address
CELL PHONE
Gender: Male Female

I am filling in this application to:
Get my first library card in Nassau County Replace a lost card
Change the name on my card Change the address on my card
Change my library district (because I have had a card at another Nassau County Library - my last address appears below)
My Previous Full Address:

If you are NOT A PORT WASHINGTON RESIDENT, but are EMPLOYED in Port Washington, please indicate the following:
Employer's Name:
Employer's Address:
Employer's Phone:

The Port Washington Public Library - One Library Drive - Port Washington - NY 11050
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