Application for Community Membership


	Application for Community Borrowing ABN 63 942 912 684

Fields marked * are compulsory
Title (Mr,Mrs,Ms,Dr.,etc.)

Last Name *

First Name and other initials *

Date of Birth * As required by the Broadcasting Services Act

Home Address *


Email Address *

Phone No. *

Home

Work

Mobile


I agree to abide by the Library Conditions of Use I have read the guide for the general public and I am aware that I will not have remote access to electronic resources.

Signature	_________________________	Date	_________________

Please hand the form in at: any Branch Library or Fax: (07) 3365 6888 or	Send to: Circulation Information Access Service Duhig Building The University of Queensland Library St Lucia 4072

You will be advised by email when your Library card is available for pickup from the Loans Desk at the Social Sciences & Humanities Library. Please note that photo ID and proof of address must be presented at time of collection.


Fee Schedule	1 year	$495.00 (GST incl.)	6 months	$250.00 (GST incl.)
	UQ students on non-accredited courses only e.g, IML at $11.00 per week (GST incl.) for duration of the course

Payment method (fee must accompany application) Payment amount:

	Cheque		AUD$ Bank Draft
	Payable to: The University of Queensland Library
	Eftpos		Visa
	Mastercard


Cardholder Name
Cardholder Number
Expiry date