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Online Form - Books on Wheels membership

Are you a current library member?*

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Family name*

Given name*

Middle name

Date of birth*

Email address*

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Any additional information for access to home?

Second contact details - Name*

Second contact Relationship to library patron- Eg: spouse, child, sibling, carer

Second contact details - Phone number*

Second contact details - Email address

Second contact details - Address

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Preferences - Format*

Large PrintRegular Print
Audio booksDVDs
MagazinesMusic CDs
Games & Puzzles

Preferences - Fiction

AdventureAustralian
Crime/MysteryFantasy
ThrillerHistorical
HumourRomance
Science FictionWestern

Preferences - Non-Fiction

GardeningArt & Craft
BiographyCooking
HealthHistory
ScienceTravel
Nature

Favourite topics

Favourite authors

Dislikes

How many items do you require per fortnight?

I agree to abide by the Membership Terms and Conditions. To read the Conditions of use in full : https://www.victoriaparklibrary.wa.gov.au/library/terms-and-conditions/membership-terms-and-conditions.aspx*

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