2. Please note this form sends an email to the State Library Help Desk. A librarian will check your information and respond during normal business hours.
4. First Name*
5. Middle Initial
6. Last Name*
8. Birth Date*
   MM/DD/YYYY
10. Email address you would like info sent to*
11. Phone Number (only used if email is faulty)
13. Please renew my card*

    1. Yes
    2. No
15. 6 digit card number if known
17. Forgot Card Number*

    1. Yes
    2. No
19. Do you have any questions?
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20. 1. Receive an email copy of this form.
21. Email address

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22. Submit

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