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Library-membership-application-form

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					                               Library membership application
Please fill in the details below to apply for membership of the Löhe Memorial Library and return your
completed form to: Löhe Memorial Library, 104 Jeffcott St, North Adelaide SA 5006

  Your details
  Name                                                                   Title

  Email address

  Address line 1

  Address line 2

  Town/Suburb

  State

  Country                                                    Postcode

  Home phone                                                 Work/Mobile phone
  Membership type
  Please indicate what type of membership you are applying for
  Student                     I am a student in a tertiary theological education course

                        I study at

                              MCD University of Divinity

                              Adelaide College of Divinity

                              Australian Catholic University

                              Tabor College

                              Other theological college

                              Other (please specify)

                        Course name
  Staff member                I am a staff member of a theological college

                              I am a staff member of a Lutheran agency

                        I work for

                              Australian Lutheran College

                              LCA (lay worker/employee)

                              LEA

                              Lutheran school (please specify)

                              Other (please specify)

  Pastor                      I am a Lutheran pastor

  ALC boarder                 I am an ALC boarder

  Personal study              I wish to join Löhe Memorial Library for personal study

  Concessions                 I am a pensioner or concession card holder

QPP/LIB/LMAF/12.01.01                         Amended: 02/05/12                                     Page 1 of 2
                                           ALC | Löhe Memorial Library
  Terms and conditions
  By submitting this form I agree to
   Comply with the conditions of membership of Löhe Memorial Library
   Pay any charges incurred for any overdue, lost, damaged or unreturned items issued on my
      membership card
   Notify the Library of any changes to this information
   Obey copyright law

  Agreement                     I have read the conditions above and agree to comply with them

  Email
                                I give my consent to receive notices by email
  notifications
  Please sign (type for email application)

  Signature                                                                Date

  Office use only
  Barcode

  Signature                                                                Date




QPP/LIB/LMAF/12.01.01                           Amended: 02/05/12                                Page 2 of 2
                                             ALC | Löhe Memorial Library

				
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