<web form - refer to last version for appropriate question flows>

First name *

Middle name

Surname *

Date of birth *

Day <drop down>

Month <drop down>

Year <drop down>

Gender <drop down>

Female

Male

Not specified

Phone *

Email *

Re-enter email address *

Residential Address (must be within NT)

Address *

Suburb/town *

State

<fill in answer with Northern Territory>

Postcode *

Postal Address *

Same as residential address

Different postal address

Are you under 18 years of age? *

- Select -

Yes

No

Would you like to join your dependent children under 18 years old while you are here? *

- Select -

Yes <conditional question to add>

No

<Conditional question>

Dependant 1 <must continue to offer additional dependants to fill in until they do not fill in details>

Full Name *

Date of Birth *

Day <drop down>

Month <drop down>

Year <drop down>

Gender <drop down>

Female

Male

Not specified

<end of conditional question>

Type of Library Membership *

Online access membership (I only intend to access the online resources)
- your library membership number will be emailed to you.

Full membership (you will need to upload proof of your current address and photo ID) <conditional question>
- your card will be sent to you in the mail.

<conditional questions>Photo ID *

A current NT Driver’s Licence OR Defence Force ID, Student Card, Interstate Driver’s Licence, Royal Darwin Hospital ID Card, Passport, 18+ Card.
Files must be less than 3 MB.
Allowed file types: gif jpg jpeg png pdf.

Proof of permanent NT residential address (if not listed on your photo ID)

Health Care Card, Pension Card, Enrolment to Vote Card, Lease Agreement, Phone/Power and Water/Credit Card Bill, Bank Statement, Any official /business letter showing name and permanent NT address.
Files must be less than 3 MB.
Allowed file types: gif jpg jpeg png pdf.

<end of conditional question>

Conditions of membership

Please ensure you have read and understood the:

• City of Darwin Privacy Statement,
• City of Darwin Libraries Membership Guidelines,
• Library & Archives NT Digital Services Privacy Policy, and 
• City of Darwin Libraries Code of Conduct before submitting your request.

Acknowledgement *

I acknowledge that I have read and understood the Library & Archives NT Digital Services Privacy Policy, City of Darwin Libraries Code of Conduct, and City of Darwin Libraries Permanent Membership Guidelines.

Agreement *

I agree to

• respect the rights and security of staff and other library users
• accept responsibility for all items borrowed on my card and to pay for replacement costs and processing fees for any items lost, stolen, or damaged
• abide by City of Darwin Libraries Membership Guidelines and City of Darwin Libraries Code of Conduct.