Patron Registration Form

Name: Date: Month January February March April May June July August September October November December - Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 -

Address:

City State Zip

Telephone: E-mail:

Please indicate your affiliation (check all that apply):

UCF: Undergraduate Graduate Faculty Staff Alumni
Other: Other FL college/University Out of State Independent Researcher

What are you using this research for?

Class Assignment
Thesis/Dissertation
Book Article Other

I would like to know if others are working on the same topic (email me)
I would like to b added to the Special Collections mailing list

I am interested in: Friends of the Library Making a donation

Please indicate how you found out about Special Collections (check all that apply):
Online Library Catalog Special Collections website
Other:

Is this your first visit to Special Collections? Yes No

I have read, understand & agree to abide by the Special Collections RESEARCH USE POLICY

Last Updated: 30-Apr-07

Need Help? Ask a Librarian | UCF Homepage | UCF Libraries Homepage | Orlando, FL 32816 | Contact Us | ©2008