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Online Library membership application

Please fill in the details below to apply for membership of the L�he Memorial Library.

Name:
Email address:
Address Line 1:
Address Line 2:
Town/Suburb:
State:		Postcode:
Home Phone:		Work/Mobile Phone:

I am a student at: (mark appropriate boxes if applicable)

	Australian Lutheran College (ALC) internal.		Burleigh College
	ALC(Flexible Education)		Tabor College
	ALC(Lutheran Strand)		Other University:
	Adelaide College of Divinity		Other Institution:
	Australian Catholic University		Bible College of SA

My course of study is: (course name)

Pensioner/Concession

Private Study

I am a theological college staff member at:
I work for (organisation/business name):

Please register me as an approved borrower of the L�he Memorial Library.
By submitting this form I agree

To comply with the conditions of membership of L�he Memorial Library

To pay any charges incurred for any overdue, lost, damaged or unreturned items issued on my membership card

To notify the Library of any changes to this information

To obey copyright law
In giving my email address I give consent to receive notices by email.
By submitting this form I am declaring that I have read the declaration above and agree to comply with the conditions of membership of the L�he Memorial Library.

Updated: 15/8/2006 [1.00]