Application for Reciprocal Borrowing

ABN 63 942 912 684

Fill out sections required, print and sign the form. 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. * (At least one)
Home Work Mobile

Enrolment/Employment details *	Staff Higher degree student External undergraduate student (from an institution outside Brisbane metropolitan area only are eligible) Internal undergraduate student (from an interstate campus only are eligible)
Student/Staff library number *
Institution *

I agree to abide by the Library Code of Practice as stated on the Library's website.
I am aware that membership does not include remote access to electronic resources.

Signature	_________________________	Date	_________________

Please hand the form in at any Branch Library. Photo ID and proof of enrolment/employment must be presented at time of application.

Fee Schedule	Staff	No charge
	Higher degree student	up to 1 year	$50.00 (GST incl.) Non-refundable
QUT, Griffith students no charge if subsidy letter produced.
	External undergraduate	up to 1 year	$50.00 (GST incl.) Non-refundable
	Internal undergraduate	up to 1 year	$50.00 (GST incl.) Non-refundable

Payment method (fee must accompany application) Payment amount:
	Cheque		AUD$ Bank Draft Payable to: The University of Queensland Library
	Eftpos	Visa		Mastercard	American Express

Cardholder Name
Cardholder Number
Expiry date

Library use only
Date received		Receipt no.
Expiry date	28/02/	Staff signature
Barcode	24067
Stat class
Paid by	Eftpos Cheque Credit Card Cash Subsidy