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Application for Adult Card

2. First Name*

3. Last Name*

5. Birth Date*
   Birth Date

6. Texas Driver's License or Texas ID Number*

8. Address*

10. City*

11. State*

12. Zip*

14. Phone Number*

15. Email

17. Password for Online Access to Library Account

    Must have at least seven (7) characters including numbers and letters.

18. Would you like to receive text notifications for items on hold?

    1. Yes
    2. No

19. If so, choose your carrier
    -- Select One --AT&T Mobility/WirelessBoost MobileConsumer CellularCricket Google FiH20 WirelessMetro PCSRepublic WirelessSprint PCSStraight Talk/Page Plus CellularT-MobileTracFoneUS CellularVerizon WirelessVirgin Mobile

21. Are you employed within the Wise County area?

    1. Yes
    2. No

22. Are you a teacher at any of the Wise County ISDs?

    1. Yes
    2. No

23. If so, which school?

Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field