<p> ______Last name</p><p>Staff Use only. Date : Bar Code : 2 4404 000 ______Date Entered: ______Initials : ______PLEASE PRINT.</p><p>Name* : (Last, First and Middle)</p><p>Please check one in each box: Circulation Type * Service Group (Statistics) * Court Staff  Gov’t employee, federal, state or municipal General Public  Lawyer Intern  Public Law Clerk</p><p>ID verification: Date of Birth : (Staff use only)</p><p>Phone 1*:  Home *</p><p>Phone 2 :  Work  Cell  Fax</p><p>Phone 3:  Work  Cell  Fax</p><p>Phone 4:  Work  Cell  Fax</p><p>(Check only one box.) *Home Address*  Prefer for all mailings Work Address  Prefer for all mailings </p><p>Line 1: Line 1:</p><p>Line 2: Line 2:</p><p>Line 3: Line 3:</p><p>City, State: City, State</p><p>Zip Code Zip Code</p><p>Email : @</p><p>I prefer to receive notices by :  Mail  Email </p><p>I agree to obey the circulation policies of the Trial Court Law Libraries, to promptly pay all fines charged for damage to or loss of materials, and to give immediate notice of any change of address. </p><p>Signature : ______</p><p>Your card will be mailed to you.</p><p>*Required fields.</p>