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ITS SIMPLE! TO PRINT OUT THIS FORM, CLICK ON THE PRINT PAGE BUTTON LOCATED ABOVE, THEN FILL OUT FORM AND MAIL IT TO THE ADDRESS BELOW!


LAST NAME:_____________________FIRST__________________________________MI___________________


ADDRESS:____________________________________________________________________________________

CITY:_______________________________________STATE______ZIP:_________________________________

PHONE:( )___________________EMAIL:____________________________________________________

DATE:_______________________________________________________________________________________

HAZLETON GENERAL HOSPITAL COMMUNITY HEALTH LIBRARY
700 E. BROAD ST.
HAZLETON, PA 18201


if you have any questions about the Library, or have trouble filling out the application form call:
(570) 501-4800