Registration form for employees of NHS Trusts and private hospital staff

Surname: (required)

Title: (required)

Forenames: (required)

Residential address: (required)

Work address: (required)

Telephone / mobile number (required)

Extension / bleep number (required)

Email address: (required)

Permanent staff? (required)

Completion date of present rotation/contract (required)

NHS Trust: (required)

Post held: (required)

nb If you work at a Private hospital e.g. Claremont, Thornbury, please complete the Fee Paying Borrower form.

Terms & conditions (required) I undertake to observe the Library Regulations and Code of Practice including the commitment to return items when due or recalled and to meet any costs or charges arising from the use of the service.

I agree to these Terms & conditions