24 hour access form

Application Form for Out of Hours Access to the Hospital Library

I wish to apply to use the Library outside normal opening hours and to be issued with a fob to facilitate access. I understand that access will be subject to the conditions of use, which I have read and accept. I authorise the Library to obtain my residence / forwarding address from my employer if it becomes necessary to contact me.

* Indicates required field

Your Name *

First

Last

Your Position *

Your Department *

Library use only:

ID/Employer checked (initial and date) *

Fob issued (initial/date) *

Own fob used (initial/date) *

User chased for fob (initial/date) *

Fob refund for libray (initial/date) *

Your Home/Residence Address *

Line 1

Line 2

City

State

Zip Code

Country

Date your contract ends (if non-permanent staff) *

I have read and agree to the conditions of use (see link above). I understand that breach of these terms may result in fob access being withdrawn *

I agree

Submit