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Application for a Library SubscriptionI hereby apply for a Subscription to the Medical Research Library of Brooklyn and agree to comply fully with all rules and regulations governing the use of the Library. I understand that non- compliance with the rules may result in confiscation of the Subscription card and denial of library privileges without refund. Name:_________________________________________________________________ Address:______________________________________________________________ Telephone:(home)________________________(work)___________________________ Occupation:___________________________________________________________ Institutional Affiliation:_________________________________________________ Subscriptions are issued annually for the period July 1 through June 30. The fee is for the fiscal year, or any part thereof and is NOT prorated. Subscriptions are NOT transferable. Reading Priveleges defined: Specifically excluded from this agreement are the use of:
Access is with the subscription card at the 395 Lenox Rd. Entrance ONLY. The subscription card must be visible on your person at all times. A passport-sized full head-shot photograph is required in order to complete your subscription application. I understand that by placing my signature below, I affirm that I have read the above information and agree to abide by all regulations. Signature:________________________________________Date:_______________ Checks should be made payable to State University of New York IFR
Acct. 900401.
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