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2. This online library card application form is for non-residents and temporary residents.
   You will be notified when your library card application has been processed and your card is ready to be picked up at the library. A photo ID must be presented when picking up your card. For non-residents, there is a $50 annual fee. This fee must be paid in order to receive library privileges. This fee is waived for educators and employees of City, County or State Government who work in Santa Rosa County with proof of employment. For temporary residents, you must provide verification of temporary SRC residence, permanent residence, and length of stay.
4. Last Name*
5. First Name*
6. Middle Name*
8. Local Street Address*
9. Effective dates for Local Address (if applicable)
   Effective dates for Local Address (if applicable) Start Date

   —

   Effective dates for Local Address (if applicable) End Date
11. City*
12. State*
13. Zip Code*
15. Home address (for temporary residents)
17. City
18. State
19. Zip Code
21. Notification Preference*

    1. Text
    2. Email
22. Phone Number*
23. Cell Phone Carrier?
    Required if you wish to receive texts.
24. Email Address*
26. Please select your preferred library*

    1. Genealogy
    2. Gulf Breeze
    3. Jay
    4. Milton
    5. Navarre
    6. Pace
28. Please read before submitting: I verify that the information above is correct. I agree that by submitting this applicaion, I assume responsibility for all use of this card, including Internet usage. I accept responsibility for all materials borrowed on this card. I agree to observe all library rules, to pay all charges, and to notify the library of any changes to my contact information.
29. By checking "agree" I am virtually signing my application.*

    1. Agree
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field