GIAL Library

Dallas GIAL Library

Borrower's card information

For staff use:

Patron ID _________

Init. _____________

Date ____________

PLEASE PRINT

Full Name:__ Dr. __ Mr. __ Mrs. __Ms. __Miss

First _____________Last ______________________

U.S. Driver's License (if you have one)

State ___No. ______________________

Have you ever had a library card from the Dallas GIAL Library before? __Yes __ No

Please check all categories that apply:

__WBT/SIL __GIAL Student __Faculty __Thesis/Dissertation

Other Campus: __UTA __DTS

__Field Member __Dallas Center __Guest Helper/WA

__Employee __International Admin

Acad. Affairs: note which dept.: __Anthro __Ling __Lite __Socio __Trans __Training __Other

Cooperatives: __PBT __Other Mission __DTS __DBU __SWBTS __Other

__Fee card __Guest card

Center Mail (Where do you receive mail on center?) __Not applicable

__Mailroom __ Dorm __ Int'l Museum of Cultures __Activity Center

__Pike __Mahler __Hunt __ Key

Other __________

E-mail address ______________Department ________

Current Home Address

House Number Street Apt. #^{___________________________}

^{City State ZIP _______________________________}

Permanent Home Address (for students)

House Number Street Apt. # ____________________________

^{City State ZIP ____________________________}

Phone Number(s)

Home (___) ____________

Office (___) ____________

I accept responsibility for all book or non-book materials borrowed on this card, and agree to pay any applicable fines or fees for lost, damaged or overdue library materials.

Applicant's Signature__________________________

PLEASE--Present your card each time you check out items.

Report loss of your card immediately.