Homebound Application Step 1 of 2 50% Participant InformationName(Required) First Middle Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Driver's License/State ID Number(Required) Birthday(Required) Month Day Year Phone(Required)Email Emergency ContactPlease list an emergency contact that we can contact if we cannot reach your regarding homebound or homebound deliveries. Alternatively, you can opt out of this service by checking the box below.Would you like to include an emergency contact on your account?(Required) Yes No Name(Required) First Last Relationship(Required) Phone(Required)Email Does this individual have authorization to get information about your account?(Required) Yes No Consent I understand that I am responsible for materials delivered to me through the homebound program, and I have read the Homebound Program Policy. Reader ProfileI want to receive deliveries…(Required) Every Two Weeks Every Four Weeks I want to recieve this item amount (Maximum 10 per delivery)1 item2 items3 items4 items5 items6 items7 items8 items9 items10 itemsMaterial Formats (Check all that Apply)Books & Magazines Regular Print Large Print Magazines DVDs Movies TV Series Binge Boxes Documentaries/Non-Fiction DVDs CDs Audiobooks Music Fiction Selections Best Sellers Adventure Literary Fiction Amish Animals/Nature Black Life Classics Fantasy Historical Holidays Horror Humor Inspirational Michigan Interest Mystery Romance Science Fiction Short Stories Sports/Recreation Thriller Westerns Check all that apply.Non-Fiction Selections Best Sellers American History Animals/Nature Art Biographies Business Cooking Folklore/Mythology Health History Michigan Interest Politics Psychology Religion Science Sports/Recreation Technology Travel True Crime War World History Other Check all that apply.Please identify what topic you would like included:(Required) Authors you enjoy include… David Baldacci Maeve Binchy Bernard Cornell Clive Cussler Richard P. Evans Fannie Flagg Joanne Fluke Neil Gaiman Sue Grafton Zane Grey Mary Higgins Clark William Johnstone Jan Karon Stephen King Karen Kingsbury Dean Koontz Kimberla Lawson Roby Beverly Lewis Debbie Macomber Mary Monroe Walter Mosely Janette Oke Terry Pratchett Nora Roberts Nicholas Sparks Danielle Steel Carl Weber Check all that apply.You do not want materials with… Sexual themes Explicit sexual content Rough/obscene language War Violence Death Disease Religion Addiction Dark or cynical humor Other Check all that apply.Please list your specific requests here:This can include favorite authors, titles, or series, or things you explicitly want us to avoid.CAPTCHA