Database Access Registration Form

To register for access to all statewide and Regional databases, complete and submit this online form, or print a paper copy (pdf, 3 pages) and return it to CMRLS.

This form should only be filled out by the Library Director or appointee.

Questions? Please contact: Rick Levine x308 rlevine@cmrls.org

Library Name:

Technical / IT Contact Person:

Contact's e-mail Address:

Contact's phone number:

E-mail Address(es) to which database usage statistics should be sent (up to 2):

How do you access the Internet in your library? Check all that apply:

CW/MARS Other*

*If you chose "Other," are your IP addresses:

Static Dynamic

Please list Library IP numbers/ranges below:

Library workstation IP#s/ranges (assigned to public and staff workstations in your library)





Campus-wide IP addresses/ranges (academic institutions and K-12 schools only):





Do you use a proxy server or firewall:          yes      no

Form to be completed by authorized library personnel only.