* Indicates required field Current residents of Williamsburg, James City County or York County, W&M alumni, and our educational partners (see full list in the form below) can apply for an account at William & Mary Libraries. Borrowing privileges include: Have up to 20 items checked out at once 30 day check out period for books One week check out period for DVDs One renewal per item Please submit the following form to apply: Your contact information Full Name Email We require an email address so that you can receive notices about items you've checked out or requested from the library catalog. If you do not have an email, please contact us at (757) 221-3072 for assistance. Address City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Additional information Driver's License Number State Issued Date of Birth Date of Birth: Day Day12345678910111213141516171819202122232425262728293031 Date of Birth: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Date of Birth: Year Year2014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900 Phone Number Category* Please select one of the following categories that best describes you. W&M Alumni Local Resident (City of Williamsburg, James City County, York County) OSHER Lifelong Learning Institute Member Virginia Teacher Jamestown-Yorktown/APVA Research Employee Faculty Consortium Member (VIVA/VTC) Student Consortium Member (VIVA/VTC) Name of Institution For Virginia teachers and VIVA/VTC members, enter the name of your institution. Agreement I agree to abide by William & Mary Libraries' regulations; if I do not return items borrowed, I will be charged a replacement value and agree to pay all costs of collection.* Including late payment fees, interest, additional fees of third party collection agencies or attorneys (up to 30% of the principal, interest and late charges accrued prior to referral), court costs and/or any other charges necessary for the collection of debt. Yes No Signature Type your name below to sign this form Today's date Leave this field blank
