FLETCHER MEMORIAL LIBRARY (FML) MEMBERSHIP INFORMATION & FORM:

Thank You for your interest in becoming a member of FML. During these days of Covid-19 it is our hope
to enable becoming a library member as easy as possible. Kindly fill out the below information. 2 nd
Homeowners, we do need your non-local address for statistical information. If you have a local phone#
please provide us with that as well as your cell. A Local # saves us cost. Any Questions – just call FML.

We require a working phone # and an e-mail. Our system functions on these two contacts for Hold
Notices, Late Notices or if there is staff communication. Promise – no spam.

I agree to follow all policies of FML, promptly pay all fines for lost, damaged or late materials, and
give immediate notice of address, phone or e-mail changes.

NAME (print): _____Nicole Cummigs

PERM. MAILNG ADDRESS: 77 Main Street TOWN: Ludlow ST ___VT___ ZIP _______05149__________

PRIMARY PHONE #: ______________315-450-4606_________

E-mail (required): ________nicole_w0508@hotmail.com__________

*A Youth under the age of 16 requires a birthdate and an Adult Member as Grantor *

NAME (print): ______________________________

2nd HOME ADDRESS: ___________________________________________________________Mailing ? Y/N ____

TOWN: ________________________________________________________ST ______ ZIP _________________

PRIMARY PHONE #: ___________________________________________________________________________

E-mail (required): ____________________________________________________________________________

My signature releases my personal information for library service at Fletcher Memorial Library. A field in my
record will be checked signifying my written permission. As well, my signature allows library staff to leave a
voice mail message with specifics of titles that are ready for pick-up or missing discs. etc. rather than a
message for you to “Please call the library.” My signature ALLOWS any YOUTH for whom I am GRANTOR to
use the library’s UNFILTERED INTERNET. I understand FML CANNOT monitor what your YOUTH may watch.

Signature: _______________________Nicole Cummings_____________

FORMS of ID (We Require Two):

 For taxpayers we have access to our service towns Grand Lists for convenience of verification
 You may scan the front of your license and e-mail that to us
 A Utility Bill, or piece of mail with YOUR NAME as a verifiable address
THANK YOU & WELCOME – WE WILL BE IN TOUCH!