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* 1. Title (Dr, Mr, Mrs etc…)

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* 2. First Name

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* 3. Last name

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* 4. Email

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* 5. Personal telephone/mobile number

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* 6. Work telephone number

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* 7. Job title

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* 8. Department

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* 9. Home address (permanent)

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* 10. Home address (temporary)

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* 11. Employer

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* 12. Work Base 

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* 13. Permanent or Temporary employment – Drop down Menu

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* 14. If temporary when does your contract expire?

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* 15. If a placement student please enter your university, course title and course finish date

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* 16. If you are a placement student, please enter your placement start and end dates (see information at end of form)

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* 17. Please indicate if you would like to have hospital books sent to your work address if you work in community, mental health or at Louth hospital 

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* 18. Work address

Placement Students

Please note that LCHS, LPFT and ULHT placement students may only join the library and borrow books for the duration of their placement(s) with the named Trusts.

Once you have joined the library please contact your local library if you have any subsequent placements so that we can update your file. You do not need to re-register each time unless your course and/or university changes.

The data from this form will be used only for the administration of services provided by the Library and Knowledge Services. By completing this form you agree to this data being held in accordance with the General Data Protection Regulation (2018) for use in any relevant local library systems (e.g. Heritage) and/or external current awareness alerting systems.

 

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