Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Single Checkbox Field *I agree to these terms and conditions.Is This a Renewal? *YesNoIf it is a renewal, do you need a replacement card?YesNoN/AIf yes, please enter your current 14 digit barcode number (if you know it).Enter your EWML Account Username (if you know it).If this is for a new card, would you like a keychain card along with your large card?YesNoHave you ever had a library card from Monroe or another Connecticut library? *YesNoIf yes, what town?Child's First Name *Child's Last Name *Child's Year of Birth *Email (Parent) *Would you like Email Receipts instead of Paper?YesNoSingle Checkbox Field *I understand that I am responsible for notifying the library immediately if my child loses their card.Primary Phone *Secondary PhoneOther PhoneI would like to receive notifications by:PhoneEmailTextFor text notifications, please provide a cell phone number:Select your carrier:VerizonAT&TT-MobileSprintOtherIf you selected other, please specify your carrier:Zip Code *Street Address (1) *Street Address (2)City *State *- Select State -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingWashington DCARMED FORCES AFRICA CANADA EUROPE MIDDLE EASTARMED FORCES AMERICA (EXCEPT CANADA)ARMED FORCES PACIFICParent Name *Authorized Users (name of spouse, child, nanny, etc.)These users are allowed to:Place Holds.View borrowing history.Pick up holds.Check out new items.Which library program notification emails would you like to receive? *AdultTeenChildrensNoneSubmit
