Proxy Borrower Form(This form should be submitted to the Library Privileges Desk - Doe Library, floor 1) To: Library Privileges Desk As a University of California Faculty/Academic Staff member at Berkeley, I request that the Library permit the person named below to withdraw books in my name for use in research. Name of proxy: ______________________________ Term of Proxy Card: __________________________ (not to exceed 30 June of the next calendar year) I understand that I am responsible for all books borrowed under this privilege; that all recall notices will be sent to me; and that I am responsible for the return of all books or the payment of replacement bills for books that are lost or damaged. Date: ________________________________ Signature: _____________________________ Print Name: ___________________________ Department: ___________________________
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