Library Patron Information Sheet
Name
Print in ink First M.I. Last
Address
Street City State Zip Code
Phone Cell
E-mail (hm) (wk)
Driver’s License # or other I.D.
Profession/Title
Company/Institution/School
Address
Street City State Zip Code
Phone Fax
General Field of Study
Particular Subject of Study
____ Would you like to be notified when new accessions (books, journals, collections) come in that pertain
to your field/subject of study? How would you like to be notified? By phone: □ work □ cell □ E-mail
Would you like to be added to our Constant Contact email list? □ yes □ no
Center members may check out materials for free! For non-members, a refundable deposit will be due upon
check out and will be returned upon check in of materials. The replacement value of materials available for
check out, along with a processing fee, will be used to determine the deposit amount. (________initials)
□ SDAC member □ Non-member
_______________________________________________________________________
Staff only
Meets Secretary of the Interior Standards __
Signed Center Access Form
Patron Type________________________ Barcode #____________________
