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* 1. Name

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* 2. Home Address

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* 3. Organization Name

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* 4. Organization Address

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* 5. Contact Number

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* 6. Contact Email

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* 7. There is a membership fee of $25 that can be paid by check or cash when you pick up your materials, or you can email our Finance team at Finance@ppgr.org to arrange credit card payment.
No cost memberships are available for those 25 and under, or those with a current student ID.

By signing below I am stating that I have read and agree to abide by the Planned Parenthood Great Rivers borrowing policies. I agree to assume complete responsibility for all resources that I borrow.

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* 8. Date Signed

Date

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* 9. Now that you've signed up for a library membership, let's set up a time for you to pick up your materials!

Pick up location: Planned Parenthood Central West End health center located at 4251 Forest Park Avenue, Saint Louis, MO 63108.

Pickup times: Below, please select the time slot that works best for you.

Please note that our team will need 1-2 business days once you have submitted this form to prepare your materials.
For example, if you place your hold at sunnenlibrary.libib.com and then fill out this form on a Tuesday, your materials will NOT be ready for pickup until Thursday at the earliest. If you select our Tuesday pick-up day, it will occur on the following Tuesday, NOT the same day. 

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