library registration

Title
Dr.Mr.Mrs.Ms.Prof.Rev.

First Name

Middle Name (optional)

Last Name

Job Title/Role

Organisation
NSFTNCHCNCCCAM CCSUEAUCSCCG Health EastCCG North NorfolkCCG NorwichCCG SouthCCG WestCSUVolunteerPrivateNHS ProfessionalOther (please state)

Work Address

Work Post Code (optional)

Work Email

Work Phone

Work Mobile (optional)

Home Address

Home Post Code (optional)

Home Email (optional)

Home Phone (optional)

ID Number

End of placement

End of course date

How you heard about the library
Information at induction sessionLibrary websiteDisplay stand informationLibrary visitLibrary championRecommendation from colleagueOther (please state)

I agree to take responsibility for items borrowed from the library and understand that I will be charged fines for late return of any such items. If I lose or damage any books in my possession, I will be responsible for the replacement of these items. I will be responsible for any fines or other costs incurred by the late return to the Frank Curtis library of items borrowed on my behalf from other libraries.

I agree to abide by the Library rules and regulations and agree that the personal data above and records of my library use may be shared with library staff in accordance with the Data Protection Act 1998. I understand that my information may be accessible to library staff at other NHS and partner organisations within the shared library management consortium to enable loans of other libraries' materials. I understand that my data will not be shared with any third party.

The personal information you have supplied in registering with Library Services is processed in accordance with the requirements of the Data Protection Act 1998. It will be held electronically in a database and some information will be held on your library membership card. It will only be used for library purposes and processes including the provision of borrowing and photocopied material. This may involve other NHS libraries or for students, their university body. Your consent to our holding this information, required by the Act, is assumed when you submit this registration form.