Book Club Member Registration DetailsBook Club Name* Type of Book Club Membership* Book Club Coordinator (BCC) Book Club Member (BCM) Member's Name* First Last If you are under 18, your parent or guardian will need to complete the parent/guardian details on the Book Club Membership form.Date of Birth* DD slash MM slash YYYY Library Notices:* Standard Mail E-Mail Email* Are you an Ipswich Library member?* Yes No Library Membership Number (barcode)If you are an Ipswich Library Member, please provide your Membership Number. Important responsibilities of each Book Club library member You are responsible for keeping your contact details up-to-date You are responsible for the security and appropriate use of your membershipI have read the Privacy Statement below and agree to conform to the rules of Ipswich Libraries and to pay any fines and make good any damage or loss which I may justly be charged.* Yes No Privacy Statement Ipswich City Council is collecting your personal information in accordance with the Information Privacy Act 2009 (QLD) so that we can process your membership application, perform our other responsibilities under the Act and provide other library services. We will not disclose your personal information outside of Council unless we are required by law or you have given your consent. By completing and signing this form and returning it to Council, we will consider that we will consider that you have given us your consent to manage your personal information in this collection notice. After you have registered for a Book Club Coordinator or Book Club Member card online, you will need to go to an Ipswich Libraries branch to pick up your Book Club card. Please allow two business days for processing – please bring proof of ID eg. your driver’s licence, Medicare card number, Rates notices, Under 18 card etc.NameThis field is for validation purposes and should be left unchanged.