Phone: 555-555-5555
Fax: 555-555-5555
E-mail: someone@example.com
YOUR LOGO HERE
Oxnard College LLRC New Patron Slip
Name:______________________________
Student Id (900#)\Licenses Number:
_______________________________________
Address _______________________________
City__________________ Zip______________
Select one of the following that represents your affiliation with Oxnard College:
Student Faculty Community Member