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2. HOMEBOUND APPLICANT INFO
4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Email Address*
16. Do you have a library card with the Stillwater Public Library?*

    1. Yes

    1. No
18. How would you like to receive your homebound deliveries?*

    1. Mobile Meals
    2. Assisted Living Center
    3. Relative or Friend
20. Fiction Reading Preferences (Select All That Apply):*

    1. Classics
    2. Sci-fi
    3. Inspirational

    1. Romance
    2. Westerm
    3. Mystery

    1. Spy/Adventure
    2. Mystery
22. Non-Fiction Reading Preferences (Select All That Apply):*

    1. Biography
    2. Cookbooks
    3. Crafts
    4. History

    1. Humor
    2. Nature/Gardening
    3. Religion

    1. Science
    2. Self-Help/Psychology
    3. Sports
24. Is there anything else you'd like us to know about your reading preferences?
26. Would you like info about using the OK Virtual Library?*

    Homebound librarians can help you download eBooks and/or eAudiobooks on a computer, smartphone, or tablet.

    1. Yes

    1. No
28. RESPONSIBLE PARTY INFO

    Who can pick up items on behalf of the homebound patron.

30. First Name
31. Last Name
33. Phone Number
34. Email Address
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field