For staff use:

Patron ID:___________

Init._____ Date______

Please detach, fill out, and attach in an email back to library_dallas@gial.edu

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

How are you affiliated with GIAL? _____GIAL faculty _____GIAL staff _____Dallas ILC staff _____SIL Member

Please list Home Country___________________________________________

Please give current branch and type of assignment___________________________________________

_____SIL Affiliate (Seed, W.A., JAARS, etc.) ____________________________________________________

_____Wycliffe member

_____Member of a Bible Translation Group. Please give name and headquarters__________________________ ____________________________________________________________

For remote users only: Is it likely that you will be assigned to Dallas and need a physical card? Yes___ No ____

E-mail address _____________________________________

Current Home Address

House Number Street Apt. # ^{___________________________}_________

^{City State ZIP ________________________________________________}

Country______________________________________________________

Permanent Home Address

House Number Street Apt. # ____________________________________

^{City State ZIP ________________________________________________}

Phone Number(s)

Home ( )__________________________

Work ( )__________________________

Cell ( )__________________________

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__________________________