Application for Community 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


I agree to abide by the Library Code of Practice I have read the borrowing 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 Memberships & Payments 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	$200.00 (GST incl.)	6 months	$150.00 (GST incl.)
	UQ students on non-accredited courses only (e.g, IML, CAP) 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	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