Use the form below to submit an application to the Waynesboro Public Libray for a membership card.

Library Card Application

First Name:

Middle Name or Initial:

Last Name:

Date of Birth:
(mm/dd/yyyy)

Voting District:

Email Address:

Street Address:

City:

State:

Zip Code:

Phone Number:

Employer:

Employer Address/City/State/Zip:

Pickup Location:
Waynesboro Staunton Fishersville Churchville Craigsville Deerfield (for reserved books)

4 Digit Pin Number:
(acts like a password when accessing your account online)

Confirm 4 Digit Pin Number:
(confirm your pin # by typing it in again)

Alternate Information

Alternate Street Address:

Alternate City:

Alternate State:

Alternate Zip Code:

Alternate Phone Number: