Health Services Library Registration Form

Please complete in full before submitting

This form is to enable staff in Solent NHS Trust to register with the Health Services Library. Once the form is completed, you will be emailed details of your borrower number and Library PIN. If you have any questions or need help, please contact us:

hslib@soton.ac.uk or via telephone on 023 8120 6541

Your card will be send out to your place of work, so please ensure that you give your full work address.

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* What is your immediate reason for applying for a library card?

I would like to borrow a book

I would like to get help finding information

I would like to request an article via inter-library loan

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* Your title

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* Your given name

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* Your family name

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* Your occupation

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* Are you permanent or temporary staff?

Permanent

Temporary

If temporary, please enter end date of contract (DD/MM/YYYY)

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* Your work address

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* Your work telephone number

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* Your service/department

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* Your work email address

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* Your home address

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* Your home email address (if this is your preferred email for correspondence)

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* You home/mobile telephone number

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* I agree to comply with the University Library regulations including notification to the Library of any changes to the information on this application.

I understand that there may be a penalty for the late return of my library books.

Health Services Library Registration Form

Please complete in full before submitting

Question Title

* What is your immediate reason for applying for a library card?

Question Title

* Your title

Question Title

* Your given name

Question Title

* Your family name

Question Title

* Your occupation

Question Title

* Are you permanent or temporary staff?

Question Title

* Your work address

Question Title

* Your work telephone number

Question Title

* Your service/department

Question Title

* Your work email address

Question Title

* Your home address

Question Title

* Your home email address (if this is your preferred email for correspondence)

Question Title

* You home/mobile telephone number

Question Title

* I agree to comply with the University Library regulations including notification to the Library of any changes to the information on this application.

I understand that there may be a penalty for the late return of my library books.

Question Title

* Enter full name to confirm

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* Date

Question Title

* What is your immediate reason for applying for a library card?

Question Title

* Your title

Question Title

* Your given name

Question Title

* Your family name

Question Title

* Your occupation

Question Title

* Are you permanent or temporary staff?

Question Title

* Your work address

Question Title

* Your work telephone number

Question Title

* Your service/department

Question Title

* Your work email address

Question Title

* Your home address

Question Title

* Your home email address (if this is your preferred email for correspondence)

Question Title

* You home/mobile telephone number

Question Title

* I agree to comply with the University Library regulations including notification to the Library of any changes to the information on this application.I understand that there may be a penalty for the late return of my library books.

Question Title

* Enter full name to confirm

Question Title

* Date

* I agree to comply with the University Library regulations including notification to the Library of any changes to the information on this application.

I understand that there may be a penalty for the late return of my library books.