2. Name (First and Last)*
4. Phone #*
5. Library Card #
7. Select a pick-up location.*

   1. Evergreen Branch (9512 Evergreen Way)
   2. Main Library (2702 Hoyt Ave)
9. Reader's Age/Grade*
11. List books the reader liked reading.*
13. Describe the readers interests. *
15. Select the number of items you'd like.*

    1. Less than 5
    2. 5-10
    3. 10-15
    4. 15-20
    5. 20-25
16. Select preferred formats.*

    1. Audiobook on Playaway
    2. Audiodisc
    3. Board Book
    4. Book
    5. DVD
    6. Music CD
    7. Other

    Click all that apply.
Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field