Member Name: _______________________________________________

Membership Number: ____________________

Address: _____________________________________________________

_____________________________________________________

Phone Number: _______________________________

$25 Registration fee enclosed: ___________

Please charge to my Visa/Mastercard. Account Number: _________________________(circle one)

Expiration date: _______________

I agree to pay a one-time registration fee of $25 for the MAIL ORDER service.
I understand that the Mechanics’ Institute will pay all postage to and from the Library, however, I agree to the following:

• To return materials promptly at the end of the six-week loan period;
• To request new materials only when materials previously borrowed have been returned;
• To use the postage-paid envelope supplied with my shipment to return materials.

Member’s Signature: ________________________________________________

Date:________________________