Library Membership Data Sharing Consent Form
Please review and provide your consent for the library to share your membership data with specified third parties for service-related purposes.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Library Membership ID
*
Which categories of your membership data do you consent to share?
*
Contact information (name, email, phone)
Membership status (active/inactive)
Borrowing history (titles, dates)
Reservation records
Other
Purpose for data sharing
*
Library service improvements
Third-party reading programs
Notifications about library events
Other specified purposes
With which third parties may your data be shared?
*
Partner libraries
Educational institutions
Service providers (e.g., event organizers)
Other
Consent duration
*
Until membership expires
One year from consent date
Until I revoke my consent
If you wish to revoke your consent in the future, please describe how you would like to do so.
Submit Consent
Should be Empty: