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Library Registration Form
Date of Application
Name (Please Print)
(Last ) (First) (Middle)
Please Check
Faculty
Staff
OSB
Ecumenical Institute
Other
Other
ID Barcode
Campus ID Number ( CSB/SJU Only / number on front of ID)
Campus Address:
Department
Building
Phone
Home Address:
Street
City, State, Zip
Phone
Work Address:
Street
City, State , Zip
Phone
E-Mail Address:
If you are currently not affiliated with this University, Please describe your reasons for wanting Library privileges:
Are you currently a patron at another educational Institution?
Yes
No
Institution Name
NOTE:
-Borrower cards are to be used ONLY by the person whose name is on the card.
-You must present your card for service.
I agree to observe Clemens/ Alcuin Library's borrowing regulations and to return all items on time. Failure to do so may result in loss of borrowing privileges.
Signature ( Please Print Your Name)
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