TO BE COMPLETED BY LIBRARY STAFF ONLY
COMMUNITY MEMBERSHIP ACCOUNT BARCODE
(excluded alumni)
LAST NAME:
FIRST NAME:
EXPIRATION DATE:
Madigan Library Membership Eligibility (Select One)
Lycoming County resident, 18 years or older
Current student, faculty or staff at higher education institute (Circle: Student, Faculty, Staff)
Name of Institution:
PCT affiliated (check one)
☐Alumni (Only for alumni prior to 2010. Alumni 2011 to current already have membership in system)
☐Board member (College or Advisory)
Name of Board:
☐Spouse, domestic partner or dependent age 15 years or older of current PCT employee
Name of Current Employee:
Personal Information - *Required
Signature Date
By signing this form, I assert that I understand the protocols, rules, and regulations of the Madigan Library and agree to adhere to them at all
times. I understand the Library staff has the right to challenge users’ actions. I understand that any violations of these regulations will result in
immediate expulsion from the Library, termination of Library membership, banning from the campus, and/or legal action.
Submit this form in person to the Madigan Library.
You will also need the following:
• A valid driver’s license, passport, or current employee
or student picture ID. Additional validation may be required.
