External Library Membership Application Form For Alumni Library Membership please use Alumni Library Membership Application Form Required fields are marked with an asterisk (*). Personal Details Title Given Name(s) * Surname * Date of Birth * Day 12345678910111213141516171819202122232425262728293031 Month JanFebMarAprMayJuneJulyAugSeptOctNovDec Year 191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020 Postal Address * Suburb * State * Postcode * Contact Number * Email Address * More InformationI am * a member of ULANZ participating university a member of another institution an Alumni applying for community membership Participating ÁñÁ«ÊÓƵ Details ULANZ ÁñÁ«ÊÓƵ * -- Please Select --Auckland ÁñÁ«ÊÓƵ of Technology Australian Catholic ÁñÁ«ÊÓƵAustralian National ÁñÁ«ÊÓƵBond ÁñÁ«ÊÓƵCentral Queensland ÁñÁ«ÊÓƵCharles Darwin ÁñÁ«ÊÓƵCharles Sturt ÁñÁ«ÊÓƵCurtin ÁñÁ«ÊÓƵDeakin ÁñÁ«ÊÓƵEdith Cowan ÁñÁ«ÊÓƵFederation ÁñÁ«ÊÓƵ Australia (formerly ÁñÁ«ÊÓƵ of Ballarat)Flinders ÁñÁ«ÊÓƵGriffith ÁñÁ«ÊÓƵJames Cook ÁñÁ«ÊÓƵLa Trobe ÁñÁ«ÊÓƵLincoln ÁñÁ«ÊÓƵMacquarie ÁñÁ«ÊÓƵMassey ÁñÁ«ÊÓƵ Monash ÁñÁ«ÊÓƵ Murdoch ÁñÁ«ÊÓƵQueensland ÁñÁ«ÊÓƵ of TechnologyRMIT ÁñÁ«ÊÓƵ Southern Cross ÁñÁ«ÊÓƵSwinburne ÁñÁ«ÊÓƵ of TechnologyThe ÁñÁ«ÊÓƵ of Melbourne The ÁñÁ«ÊÓƵ of New EnglandThe ÁñÁ«ÊÓƵ of New South WalesThe ÁñÁ«ÊÓƵ of NewcastleThe ÁñÁ«ÊÓƵ of Queensland The ÁñÁ«ÊÓƵ of Southern QueenslandThe ÁñÁ«ÊÓƵ of SydneyThe ÁñÁ«ÊÓƵ of Western Australia ÁñÁ«ÊÓƵ of AdelaideÁñÁ«ÊÓƵ of CanberraÁñÁ«ÊÓƵ of Canterbury ÁñÁ«ÊÓƵ of Notre Dame AustraliaÁñÁ«ÊÓƵ of OtagoÁñÁ«ÊÓƵ of South Australia ÁñÁ«ÊÓƵ of Tasmania ÁñÁ«ÊÓƵ of Technology, SydneyÁñÁ«ÊÓƵ of the Sunshine Coast ÁñÁ«ÊÓƵ of Waikato ÁñÁ«ÊÓƵ of Western SydneyÁñÁ«ÊÓƵ of WollongongVictoria ÁñÁ«ÊÓƵVictoria ÁñÁ«ÊÓƵ of Wellington I am a*-- Please Select --Student - undergraduateStudent - postgraduateStaff - academicStaff - professional Staff or Student ID Number * Proof of Enrolment *(Document upload must be in jpg, pdf, doc or docx format and cannot be larger than 5Mb in size) Proof of Address If you cannot provide Proof of Address, you must agree to the following: I agree to produce the Proof of Address on the day of collection of the ID Card Other Institution Details Select your institution * -- Please Select --Australian Institute of Health and Welfare - staff only Calvary Health Care, ACT Canberra Institute of Technology - staff and studentsIllawarra Retirement Trust (Kangara Waters residents) National Gallery of Australia Research Library - staff only National Sports Information Centre - staff only U3A (ÁñÁ«ÊÓƵ of the 3rd Age) Alumni Details Alumni ID Number * Alumni Confirmation e-mail * Alumni confirmation e-mail can be obtained by contacting the Alumni Office (Document upload must be in jpg, pdf, doc or docx format and cannot be larger than 5Mb in size) Proof of Address If you cannot provide Proof of Address, you must agree to the following: I agree to produce the Proof of Address on the day of collection of the ID Card Community Membership Select Membership Option * 3 months for $27.50 6 months for $49.50 12 months for $99 Proof of Address If you cannot provide Proof of Address, you must agree to the following: I agree to produce the Proof of Address on the day of collection of the ID Card Terms and Conditions *As a UC library member you can assist us by:- being considerate of other library visitors and respecting their rights- treating the library and library property with care- advising us of any changes to your contact details- being responsible for all items borrowed on your membership card- taking responsibility for returning items on or before the due date, and paying any overdue fees- contacting us if you are unable to renew or return items by the due date- paying replacement costs for any items lost or damaged- advising us if your card is lost or stolen I have read and accept the terms and conditions of the ÁñÁ«ÊÓƵ of Canberra Library
