Membership Form

All NHS staff in Gloucestershire are entitled to join the library and Students who are currently on placement.
Please complete this form after reading the terms and conditions,then submit.

Details marked * must be filled in or we cannot process your request.

Staff or Student *
Surname *
Forename(s) *
Your Email *
Confirm Your Email *
Job Title
Work Telephone number / bleep
Ward Or Department *
On which site are you based? *
For Other, (Please State)
Professional Group *
For Other, please state
Home Address *
Phone Number
Contract end date(if applies)
Employing Organisation *
For other please state
Library Card No. (If Known)

     (for accessing electronic resources)
University or College
Title of Course
Borrowing Responsibilities
Each reader is responsible for all items issued to their borrower card until all loans have been returned
The Library Service must be notified of any change of address or relevant personal details
Borrower cards can be used at any other Southwest or Thames Valley / Wessex NHS Library provided that library's rules and regulations are adhered to
It is the reader’s responsibility to return items to this Library on or before the due date
We will charge fines for the late return of loans at a rate of 20p per day per book up to a maximum of £10 per book
If items are still not returned after the receipt of overdue notices (sent via email), a charge for the cost of the item will be made
Readers must comply with the Copyright Law in their use of any material they borrow or use in the Library

Data Protection
I understand my personal responsibilities under the General Data Protection Regulation (2018) and Records Management Code of Practice for Health and Social Care (2016) in particular: to ensure that to the best of my knowledge, data used by me is accurate and, where necessary, kept up to date.
I accept that my details here will be held on library management systems in accordance with the Records Management Code of Practice for Health and Social Care (2016). They will only be used for legitimate library processes by library staff or a third party to facilitate an effective service.
I understand that my information may be kept electronically and in paper format for a maximum of 5 years.
I understand full guidance on library responsibilities under the GDPR and RMCPHSC are available on the website   to read.