Lyell McEwin Hospital Library

Library Membership Form - Staff

Given Name:

________________________________________________

Surname:

________________________________________________

Department:

________________________

Contract Employees only - Contract Ends:

Position: ______________

________________________

Phone (Home): __________________ Phone (Work)___________________

Mobile ____________________________________________________
Pager _____________________
Home Email: __________________________________________________
Home Address: ______________________________________________
______________________________________________ Postcode:_______
* * * IMPORTANT please read below before signing!! * * *
I agree

to abide by the policies of the Lyell McEwin Hospital Library

to inform the library immediately if any of the above details change

to be responsible for all library materials I use and to pay for any damaged or lost items

to return or renew items by their due dates, or accept suspension of my borrowing rights for
a period determined by the LMH Library

I certify that the information I have supplied on this form is correct.

Signature:

_____________________________

Date: _______________

-----------------------------------------------------------------------------------------------------------------------Library Use Only:

ID Sighted:..

Record No.: .

Date: ..

Initials: