ARCHIVE AND DOCUMENTATION CENTRE - CARDOC Access form to the reading by xit16869

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									                                  ARCHIVE AND DOCUMENTATION CENTRE - CARDOC
                                           Access form to the reading room
Author                                                                             Validated, approved par                 Langage         Type
ms                                                                                 ms                                      EN              normal
Reference                                                                          Date                                    Version         Pages
Access_en.doc                                                                      17/02/2005                              1.00            1/1




 TITLE, SURNAME, FIRST NAME .....................................................................................................
 ADDRESS : ...........................................................................................................................................
 TELEPHONE : ......................................................................................................................................
 FAX : .....................................................................................................................................................
 E-MAIL : ...............................................................................................................................................




 NATIONALITY : ..................................................................................................................................
 PROOF OF IDENTITY : ......................................................................................................................
 STATUTE / PROFESSION / ORGANISM : ........................................................................................
 LANGUAGES : .....................................................................................................................................




 DURATION OF STAY: FROM ............................................ TO .......................................................
 FIRST VISIT :                 YES            NO
 PURPOSE OF RESEARCH : ...............................................................................................................
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 ................................................................................................................................................................
 ________________________________________________________________________________
 is authorised to visit the Archive and Documentation Centre - CARDOC

 THE UNDERSIGNED HAS READ AND ACCEPTED THE RULES GOVERNING THE
 USE OF THE READING ROOM



 DATE : ..................................................................................................................................................
 SIGNATURE OF VISITOR : ...............................................................................................................




 DATE : ..................................................................................................................................................
 SIGNATURE OF CARDOC OFFICIAL : ...........................................................................................

								
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