Online Library Card Application

Do you live in the Chelsea Library District? (required) :: Please Choose OneYesNo

Are you renewing an existing Library Card? (required) :: Please Choose OneYesNo

If renewing, what is your current card number ::

Please provide a VALID Email Address (required) ::

Would you like to get our Weekly eNews letter via eMail (required) :: Please Choose OneYesNo

Driver License: FRONT (required)

Driver License: BACK (required)

First Name (required) ::

Middle Name ::

Last Name (required) ::

Address1: Number, Street, Apt# [If Any] (required) ::
Address2: (If needed) ::
City (required) ::

Zip Code (required) ::

Township (required) ::

Phone (required) ::

Would you like to receive TEXT Messages (required) :: Please Choose OneYesNo

If YES, who is your mobile service provider? ::

Military Service? :: NoneActive DutyVeteran

Driver License Number (required) ::

Date of Birth (required) ::

I certify that the information on this form is correct. I accept responsibility for the materials borrowed on the library card issued from this application. Responsibility for the choice of materials borrowed rests with the person who filled out this application and not with the Chelsea District Library or its staff. (required) :: Please Choose OneYesNo