Application for Library Membership
Temporary Visitors (Not on a University system)
ABN 63 942 912 684
Fill out sections required, print and sign the form.
This section is to be completed and signed by the applicant. The Letter of Introduction and Indemnity is to be completed and signed by the Head of School.
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

Departmental Address *

Home Address *
Email Address *
Phone No. * (At least one)
   Home     Work     Mobile  

Home institution *
   I agree to abide by the Library Code of Practice as stated on the Library's website.
   I have read the membership guide for the general public and I am aware that membership does not include access to electronic resources.
Signature _________________________ Date _________________
 
Library use only
Date received 
Expiry date 
Barcode24067
Patron type 
Stat class