INTERLIBRARY SERVICES, 133 DOE LIBRARY, UNIVERSITY OF CALIFORNIA, BERKELEY CA 94720-6000

Special Library Access Enrollment Form

INSTRUCTIONS:
Complete form, enclose payment, and send to:
        SLA Service, 133 Library, University of California, Berkeley, CA 94720-6000
Minimum deposit is $200.00 Enrollment fee is $50.00 (non-refundable)
Submit payment (minimum $250.00) in one of the following forms:
    1. A check made payable to "The Regents of UC"
    2. Circle one:  VISA/MASTERCARD/DISCOVER/ATM [ ___ VISA ___ MASTERCARD]

Amount of charge $____________________ 

Name as it appears on the card____________________

Card number__________________________

Expiration date _____/_____(mm/yy)


Organization: ____________________________________   Telephone: (___)__________
Organizational type:  ______________________________   Fax:            (___)__________
Email: ___________________________________

Person(s) authorized to use the account (maximum of five people):

_______________________ _______________________ _______________________
_______________________ _______________________

Mailing Address
(Street address required for UPS delivery)

Billing Address (if different)

___________________________________ ___________________________________
___________________________________ ___________________________________
___________________________________ ___________________________________

Deposit Amount (Minimum: $200):

$ _______________

Enrollment Fee ($50):

$ _______________

Total Enclosed:

$ _______________

In accordance with Library Circulation Policy, I accept responsibility for the safe handling and timely return of all material borrowed. I understand that the safety of borrowed materials is the responsibility of the borrowing library from the time the material leaves the lending library until it is received by the lending library, and that all costs for repair of damage or replacement of lost material must be met by the borrowing library. (National ILL code, 1980, IV.I)

I accept full responsibility for compliance with U.S. copyright law (Title 17, U.S. code) when making requests for photoduplication. I understand that photocopy or other reporduction is "not to be used for any purpose other than private study, scholarship, or research." I understand that use or reproduction for purposes in excess of "fair use" may result in liability for copyright infringement.
 

__________________________________
Signature

__________________________________
Date

__________________________________
Print Name

__________________________________
Title


| Special Library Access Service |
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The Regents of the University of California. All rights reserved.
Last updated 07/07/11. Content maintained by: Interlibrary Services staff.