Application for Reciprocal 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

Enrolment/Employment details *

    Staff
    Higher degree student
    External undergraduate student **
    Internal undergraduate student **

Student/Staff library number *

Institution *

**Note External undergraduates from an institution outside Brisbane metropolitan area only are eligible. Internal undergraduates from an interstate campus only are eligible.
I agree to abide by the Library Conditions of Use and the Reciprocal Borrowing guide .
I am aware that membership does not include remote access to electronic resources .
Signature _________________________ Date _________________
Photo ID and proof of enrolment/employment must be presented at time of application.
Please hand the form in at any Branch Library
Fee Schedule Staff No charge
Higher degree student1 year$50.00 (GST incl.) Non-refundable
QUT, Griffith students no charge if subsidy letter produced.
  External undergraduate1 year$50.00 (GST incl.) Non-refundable
  Internal undergraduate1 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    
Cardholder Name

Cardholder Number

Expiry date

Library Use Only
Date Received  
Expiry Date 28/02/
Barcode 24067
Stat class  
Paid by     Eftpos      Cheque      Credit Card      Cash      Subsidy
Receipt Number  
Staff Signature