External borrower registration form

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LIBRARY SERVICES
External Borrower Registration form
Please tick as appropriate
CAVAL/ULA
Institute
La Trobe Alumni
Community borrower
Mr/Mrs/Miss/Ms
First name
Middle name
Last name
Preferred name
Date of Birth
/
/
Sex
Mailing address
Postcode
Email address
Telephone
Home
Mobile
I understand the conditions applied to borrowers, and agree to using the facilities under
these conditions.
Signature
Staff Use Only
Student ID / Library no:
Entered LMS by:
FIA-19
Expiry date
/
/
Date
/
/
Issued: 15/02/2012
© Goulburn Ovens Institute of TAFE 2012
(Public Web Site)
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