For new book club registrations only. Only Book Club Coordinators fill in this form. To register your club with the Ipswich Library, please fill in the following details. Book Club Registration DetailsBook Club Name* Coordinator's Name* First Last Email* Phone*Are you an Ipswich Library member?* Yes No Library Membership Number (barcode)If you are an Ipswich Library Member, please provide your Membership Number. How many members are in your club (not including yourself)?*What year was your book club formed?*I 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.Book Club Public DetailsOnly complete this section if you would like your Book Club contact details to be publicly available on the Ipswich Libraries website and you are open to having new members.I consent to our Book Club details being made available on the Ipswich Libraries website. Yes No Only provide consent if your book club is open to having new members.Contact Number and/or Email to display for Book Club Suburb your Book Club meets in What day and/or time the Book Club meets CommentsThis field is for validation purposes and should be left unchanged.