Membership Application Form
MEMBERSHIP APPLICATION
Please use block capitals
Surname ………………………………………………………………
Forenames ………………………………………………………………
Title ………………………………………………………………
Position or occupation ………………………………………………………………
Permanent address ………………………………………………………………
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Telephone number ………………………………………………………………
Email address ………………………………………………………………
Specific research interest ………………………………………………………………
Categories Please tick one
a) General â–¡ £30 annual subscription
b) Ministers â–¡ £20 annual subscription
c) Online member â–¡ £25 annual subscription(non-borrower)
Denomination ………………………………………………………………
I agree to observe the rules of Dr Williams’s Library, and make good any loss or damage that may occur to items I use or borrow from the Library.
Signature ………………………………………………………………
Date ………………………………………………………………
Applicants must provide two guarantors unless applying for an online/non-borrowing membership. Please turn over the page for the second part of the application.
STAFF USE ONLY
Registered by: Expiry date:
Number:
GUARANTEE
Two guarantors are required for Membership of Dr Williams’s Library:
1) A householder to whom the applicant is well known.
2) A person currently holding a responsible appointment that is easily verifiable, such as a Minister, Professor, Headmaster, Librarian or JP.
We, the undersigned, commend the person submitting this application, and
undertake to be responsible for any items they borrow from the Library.
1) Full name ………………………………………………………………
Signature ………………………………………………………………
Date ………………………………………………………………
Position or occupation ………………………………………………………………
Permanent address ………………………………………………………………
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Telephone number ………………………………………………………………
Email address ………………………………………………………………
2) Full name ………………………………………………………………
Signature ………………………………………………………………
Date ………………………………………………………………
Position or occupation ………………………………………………………………
Permanent address ………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
Telephone number ………………………………………………………………
Email address ………………………………………………………………
Completed forms, with payment, must be returned to the Library at least three working days prior to borrowing. Cheques are to be made payable to ‘Dr Williams’s Trust’. Standing Order forms are available on request.