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2. First Name
3. Last Name
5. Title of the Material*

   Fill in the material's title.

7. Author of Material*

   If requesting a book, please provide the author. If requesting a DVD, please provide an actor/actress name.

9. Material Type*
   -- Select One --DVDBook - Standard TypeBook - Large TypeVideo GameOther
10. If you selected Other, please explain
12. Request Type*

    1. Request item through Interlibrary Loan
    2. Requested item for the Library Collection
13. Do you want to request the item?*

    1. Place the item on hold for me
15. Are you a current patron?*

    1. I am a patron of the Blair Public Library and Technology Center
17. Any other information?
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19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field