Registration Form: RNIB Library Service If you’d like us to fill the form in for you over the phone, please call Customer Services on 0303 123 9999. Part A - Personal details Title (Mr/Mrs etc): First name: Surname: Date of birth: Address: Postcode: Telephone number (home): Telephone number (mobile): Email address: Alternative delivery address Contact name: Address: Postcode: Telephone: B – supporting people with sight loss B charity numbers 226227, SC039316 and 1109 Part B - Statement of eligibility I declare that I am eligible to join and use the RNIB Library Service due to being blind; or partially sighted; or having an impairment that prevents or limits me from reading standard print. I understand and agree that books borrowed from these services remain the property of RNIB and should be returned after reading or listening. I warrant that I will only use the service for my personal use and will not distribute, permanently store electronic copies, broadcast or publicly perform audio content, borrowed from RNIB. Signature of applicant, or responsible adult authorised to act on behalf of an eligible minor (i.e. someone under 16 years of age) Signature: Date: Part C - Which Library Service do you require? If you want Talking Books only, please go straight to Part D – Talking Books Service. For all other formats, enter yes after each type of book or resource that you’d like to borrow from the following six choices:Giant print books: Braille books: Materials for adult Braille learners: Braille music resources: Large print music resources: Audio tutorial music CDs: NL10003P (November 2015) 2 Now let us know how many books you’d like to borrow at any one time in each format. Please enter a number after each of your chosen formats, to a maximum of six each:Giant print: Braille: Materials for adult Braille learners: Braille music resources: Large print music resources: Audio tutorial music CDs: Part D - Talking Books Service If you would like to borrow Talking Books, please let us know how many Talking Books you’d like to borrow at any one time. Please enter a number, to a maximum of 6: How would you like to receive your Talking Books? Enter yes after your preferred choice from this list of four different format options:Talking Books by Digital Download (RNIB Overdrive): Talking Books on DAISY CD: Talking Books on USB Stick: Talking Books on a combination of DAISY CD and USB Stick (if you want this option, please indicate how many of your titles you would like on USB Stick at any one time, i.e. between 1 and a maximum of 5): NL10003P (November 2015) 3 Part E - Choosing your books How would you like to choose what to read/listen to? Enter yes from these three choices:Send only the specific titles I request: I’d like to select some of my own books, but please select books for me as well: Please select books for me: What types of books do you like? Enter yes after each of your favourite categories:Fiction Adventure: Animal stories: Canadian Library fiction: Chick lit: Children’s stories: Classic fiction: Classic crime: Country life: Crime fiction: Erotic stories: Family stories: Fantasy: Folklore and Fables: Gay fiction: General fiction: Ghost stories: Historical crime: Historical fiction: Historical romance: Horror: Humourous: Literary fiction: Magic and Fairytales: NL10003P (November 2015) 4 Mills and Boon Romance: Myths and Legends: Religious fiction: Romance: School stories: Science fiction: Sea stories: Short stories: Thrillers/spy stories: War fiction: Westerns: Young adult: Non-fiction (other categories are available) Biography: History: Natural History: Poetry: Politics: Science: Sport: Travel: True crime: War non-fiction: Who are your favourite authors? Please tell us below (we recommend including at least 5 authors to ensure a wide choice): Please list any other areas of interest: NL10003P (November 2015) 5 From time to time we could provide you with a book that you have previously read/listened to. Do you want us to do that? Please state yes or no: If you do NOT wish to receive Talking Books that contain the following, please enter no after these three categories:Strong language: Sexual content: Violent content: For note: Unfortunately, we don’t have the capability to apply the same warnings to other types of Library stock. New Books and Read On e-newsletter Would you like to receive our regular New Books publication? Please state yes or no: If yes, what is your preferred format for New Books? Enter yes after the relevant option from the following five types:Email: DAISY CD: USB: Giant print: Braille: Would you like to receive our monthly Read On newsletter by email? Please state yes or no: Please note, if ‘yes’, we will need your email address in Section A. NL10003P (November 2015) 6 Part F - About you Please indicate with a yes after the relevant option(s), if you are:Blind: Partially sighted: Print impaired: If you have another form of impairment, please outline below: If you are blind or partially sighted, are you registered? Please state yes or no: How should we write to you? Enter a yes from this list of four choices:Email: Giant Print: Braille: Audio CD: We have an enthusiastic and experienced volunteer team based across the UK that can assist you with your reading choices and accessing library services. Would you be interested in receiving a visit or a call from one of our local volunteers? Please state yes or no: Alternatively, you may have a friend or family member that might be able to assist you in accessing the RNIB Library/Talking Books Service. If you have someone who would be happy to support you in this way, and you wish us to contact them, please give us their details:NL10003P (November 2015) 7 Relationship to you (e.g. relation, friend, neighbour etc.): Title (Mr/Mrs etc): First name: Surname: Address: Postcode: Telephone number (home): Telephone number (mobile): Email address: We’d like to send you information from time to time that may be of interest to you. Enter yes after each of the following that you’d like to receive information about:Products / services: Ways to support RNIB: RNIB may from time to time pass your details on to reputable external organisations. May we pass your details on? State yes or no: We would like to know where you found out about RNIB Library. Please indicate with a yes after the relevant option(s):Direct from RNIB: Local Authority (Council): Local Society: NL10003P (November 2015) 8 Friend or Family member: Other: Part G - Returning the form Many thanks for completing this form. Please send your completed form to: RNIB Library Services PO Box 173 Peterborough PE2 6WS We have included a pre-addressed return envelope, for your convenience. No additional postage is required. Your application should take five to seven working days to process. If you haven't heard from us within 14 days of sending your registration form, please contact us on 0303 123 9999. If you need help, or have any questions, you can contact us in the following ways: Telephone: 0303 123 9999 Fax: 01733 375001 Minicom: 0845 758 5691 Email: Helpline@rnib.org.uk For more information about all the reading choices we offer, please visit our website at www.rnib.org.uk, or the RNIB Library catalogue www.rniblibrary.com, where you can search our collections. Welcome to RNIB Library! NL10003P (November 2015) 9