|
Library request form
Name_______________________________________________________ Address_____________________________________________________ ___________________________________________________________ Telephone number______________________ Email __________________________ Book(s) wishing to borrow (six week loan period): Book Title Author 1) 2) 3) 4) Tapes/Videos/CD(s) wishing to borrow (six week loan period): 1) 2) 3) I am a BSA member/qualified speech and language therapist (delete as applicable). Maximum loan six items. Please make cheques payable to British Stammering Association Total amount paid:_________________ Date:_________________ Please help us by returning your books/tapes/videos/CDs to us, as they are due, so that we can keep our records up to date, and, most importantly, others can continue to benefit from this Library Loan Service. We depend on your co-operation. Thank you. For Office Use only:
The British Stammering Association is a company limited by guarantee registered in England No. 4297778. |
Please print off this form and return it with your cheque to: British Stammering Association, 15 Old Ford Road, London E2 9PJ.