Application for Membership of the Library Please write clearly in BLOCK CAPITALS Full Name: I am: Trust Staff □(TS)
Service User □ (SU) Volunteer □ (VR)
Address:
Member of the Public □(MP)
Which borough do you live in? Camden □ Islington Other
□ □ ……………………. (please state)
Date of Birth: Email: Telephone home: mobile: Do you have any access needs? Who would you like us to contact in case of emergency? (e.g. friend, family member, neighbour, care co-ordinator) This might be in case you were taken ill whilst you were here, or perhaps if there was a fire and we could not locate you.
Please provide a utility bill, benefits letter or bank statement with this form for your proof of address, and some photo I.D. so that we know this is you. Date:
Signed:
…............................................................................................................................................................... Office use only Has the.... (Please write below what item was shown) Address document been copied
□ .............................................................
ID document checked
□ .............................................................
By:
Card produced date:
Library Membership number:
Card Issued date:
(Number is 4 numbers and 2 letters e.g TS0045 or SU0057))
File this sheet in the blue library ring binder which lives at the reception desk Librarymembershipform v7 Dec 15 Bev