Membership Application

Hours:

Mon - Thu: 10:00 to 9:00
Fri & Sat: 10:00 to 5:00
Sunday: 12:00 noon to 5:00

Click here for closure dates

Coquitlam Public Library
Membership Application

This online form is provided for patron convenience, but is not encrypted in transmission. For greater protection of your personal information, please visit your local branch to fill out this form in person. If you are under 14 years of age, the Library will also require the signature of your parent or guardian before issuing your card. If neccessary to recover overdue materials, the Library may release borrowing information to your parent or guardian.

	*	First Name:

		Middle Name:

	*	Last Name:

	*	Street Address:

	*	City:

		Postal Code:

	*	Telephone Number (Home):

		Telephone Number (Work):

		Email:

	*	Birth Date (mm/dd/yyyy):

	*	Gender: FemaleMale

	*	I would like to pick my card up at: City Centre BranchPoirier Branch

The information on this form is collected under the authority of the Library Act (SBC 1994, c31) and is needed to process your application for a library card. The information may be used to verify your eligibility for borrowing privileges, including your debt status with other area libraries, and may be retained as a record of your agreement to be responsible for all materials borrowed on your library card. Submitting this form authorizes the Coquitlam Public Library Board the right to release to third parties information acquired on this application for the purpose of locating users who are in violation of library rules. If you have any questions please contact the Freedom of Information Officer at 604-937-4147 (575 Poirier Street, Coquitlam BC V3K 6A9).

I hereby agree to abide by the rules of Coquitlam Public Library Board and to be responsible for the choice and safe return of all materials borrowed and debt incurred against my card.

Library Locations
Poirier Branch 575 Poirier Street Coquitlam, BC V3J 6A9 604-937-4141		City Centre Branch 3001 Burlington Drive Coquitlam, BC V3B 6X1 604-927-3562