Application for Retired Staff 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
Retired UQ Staff Position
Years of service
Staff number
I agree to abide by the
Library conditions of use
as stated on the Library's website.
I have read the
membership guide for retired staff members
and I am aware that membership does not include remote access to electronic resources.
Signature
_________________________
Date
_________________
Please hand the form in at:
any Branch Library
or
Fax:
(07) 33656888
or
Send to:
Circulation
Information Access Service
Duhig Buliding
The University of Queensland Library
St Lucia 4072
Library use only
Date received
Expiry date
Barcode
24067
Patron type
Stat class
