APPLICATION FORM FOR FREE LIBRARY CARD APPLICANT

							APPLICATION FORM FOR FREE LIBRARY CARD

APPLICANT:
             Ms      Mr
Name


Address


Zip code/ City                                                                                 Phone


E-mail address


Identification type & number                                                            Date of Birth



REFERENCE (if applicable):
             Ms      Mr
Name


Position Title


E-mail address                                                                                 Phone



MOTIVATION FOR REQUESTING FREE LIBRARY CARD:




Date:




You can complete this form using your computer. After you have completed the form, you have to
save it and attach it to an e-mail. Send your request to: uitleen@library.leidenuniv.nl.

A library card costs € 20,- per year. With this library card you    Review of this regulation is done in advance. A free library card
can make use of the services of the Leiden University Libraries.    will only be provided very exceptionally. You will receive the
Further information can be found at www.library.leiden.edu.         answer to your request as soon as possible through e-mail. Filling
By fully completing this form you are requesting the Leiden Uni-    out this form does not guarantee that your request will be granted!
versity Libraries to provide you with a free library card. A free
library card can only be granted if you provide a valid reason.




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