Library application form (Word) - RNIB



RNIB NATIONAL LIBRARY SERVICE

Registration Form

Please return to:

PO Box 173

Peterborough PE2 6WS

This form can also be completed by telephone.

Tel: 0303 123 9999

Fax: 01733 375001

Minicom: 0845 758 5691

E-mail: library@.uk

Website: .uk/library

Opening hours: Monday to Friday 8.45am-5.30pm; (closed Thursday 2.30pm-4.30pm)

PART A - Reader's details

Title (Mr/Mrs/Miss/etc):

Surname:

First Name:

Date of Birth:

Address:

Postcode:

Telephone Number:

Email Address:

Second address

We can arrange to send your books to a different address if this helps you (e.g. school, college, work). Please give details if required:

Contact Name:

Address:

Postcode:

Telephone:

Email Address:

PART B - Library services required

Enter yes or no at the end of the line where appropriate.

Giant print books (free) :

Braille books (free):

Materials for adult braille learners (free):

Music resources (free) braille:

Music resources (free) Giant print:

Audio tutorial music CDs:

Talking Books on Daisy CD

(Annual subscription fee £50- less than £1 a week).

DAISY CDs can be played on many MP3 CD players or a specialist DAISY player. RNIB can offer advice about a player that may suit you.

Call Helpline 0303 123 9999

Do you require children's titles?

Would you be interested in downloading audio books from RNIB in the future?

Part C - How to make a payment for a Talking Book subscription

There is an annual subscription fee. This may be paid by your local authority or you can pay for yourself. A Talking Book subscription also makes an ideal gift - a present that can be enjoyed all year round - call us on 0303 123 9999 for details.

If you are paying for your own subscription - you will need to send payment with your completed application form. You can pay by direct debit, credit/debit card or by cheque.

Cheque/postal order should be made payable to RNIB and sent to: RNIB Talking Book Service, PO Box 173, Peterborough PE2 6WS.

Please ring us on 0303 123 9999 to pay by credit/debit card or set up a direct debit.

Do you wish to pay:

Quarterly:

Six monthly:

Annually:

10 monthly payments (Direct Debit only):

Enter yes or no at the end of the line where appropriate.

Who will be paying for your Talking Book subscription?

Enter yes or no at the end of the line where appropriate.

Yourself:

Local authority:

Local Society:

Other (e.g. relative, carer):

If someone else is paying for your subscription

(e.g. local authority, local society or relative/carer) - please provide their details below:

Name

Address

Postcode:

Telephone Number

Email address

PART D - Using the RNIB National Library Service

Number of books

We will replace your books as soon as you return them. We recommend that you return a book as soon as you have finished it. You can borrow up to six titles per format at any one time. Please state below how many books you wish to borrow:

Talking Books:

Giant print:

Braille:

RNIB has put a warning on Talking Books if they contain material unsuitable for family reading. Please state here if you do NOT wish to receive books which contain strong language, sexual or violent content.

Choosing your books

Enter yes or no at the end of the line where appropriate.

Send only the specific titles I request. Do not select books for me.

I wish to select my own books but please select books for me as well:

In order to provide your library service, we prefer you to give us a list of titles that you would like to read, but you may also wish to indicate your favourite categories from the list below so that we can ensure you are never without a book to read. Alternatively, our Reader Services Team (Tel: 01733 375333) can help you compile a list or send you book lists to choose from.

Fiction

Adventure

Chick lit

Classic fiction

Crime fiction

Erotic stories

Family stories

Fantasy

General fiction

Historical fiction

Horror

Romance

Science Fiction

Short stories

Sea stories

Thrillers/spy stories

War fiction

Westerns

Non-fiction

Biography:

History:

Country life:

Poetry:

Politics:

Science:

Sport:

Travel:

True crime:

War non-fiction:

Who are your favourite authors?

Please list any areas of interest

(e.g. gardening, cookery)

Read On and New Books

When you join RNIB National Library Service, you will receive our free 'Read On' magazine and 'New Books', a bi-monthly update of new titles available from RNIB for loan and/or sale. Please indicate your preferred format for:

Enter yes or no at the end of the line where appropriate.

Read On in Clear print

Read On on DAISY audio

Read On in braille

Read On by email

New Books in Clear print

New Books on DAISY audio

New Books in braille

New Books by email

PART E – Who can use our services ?

You are can join RNIB National Library Services if you are unable to comfortably read standard print with spectacles. You don’t need a GP or other professional’s verification.

Enter yes or no at the end of the line where appropriate.

If you are a teacher acting on behalf of a child or young person, do you have permission from their parent/guardian?

Terms and conditions

I understand that books under RNIB's loan scheme remain the property of RNIB and must not be copied, broadcast or publicly performed.

I declare that I am eligible for the service due to impaired reading vision (unable to comfortably read standard print with spectacles).

Signature:

PART F - About You

Enter yes or no at the end of the line where appropriate.

Please tell us if you are :

Blind:

Partially sighted:

Are you registered?

How would you like us to write to you?

Clear Print:

Braille:

Audio CD:

E-mail:

Please tell us where you heard about us.

Local Authority:

Local Society:

School/college:

Library:

Hospital:

Friend, relative or carer:

Exhibition:

Leaflet:

Newspaper/magazine:

Website:

Radio:

Talks:

Another part of RNIB:

Other (please specify):

Occasionally, RNIB may wish to contact you with information which may be of interest to you. May we send you information about:

Products:

Services:

Ways to support RNIB:

RNIB may from time to time pass your details on to reputable external organisations.

May we pass your details on?

Thank you for joining RNIB National Library Service.

Your application should take five to seven working days to process. If you haven't heard from us within 14 days of your application, please contact us on 0303 123 9999.

Registered Charity No 226227

VAT Registration No. 524 4558 45

NL10003P

November 2013

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download