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Online registration form for NHS remote users

If you are an NHS employee in South West London and wish to join the library remotely, simply fill out the form below and hit submit.

You must show your staff ID card at the library main desk during normal office hours, in the first instance, before you become eligible to borrow or reserve books.

Title (Mr, Mrs, Dr etc )
Forename *
Surname *
Job title *
Department*
Work tel*
Work Email address*:
Personal email
Home address*:
Postcode
ID badge number:
Bleep/Pager if applicable:
Employer
Other -Please state
I am a permanent / temporary member of staff	No Yes
If temporary, contract ends on
If placement student, state university and course
Placement end date
Tick box to request an NHS Athens account ( Electronic Resources Password)	Athens Acccount
Tick box: If you have need help with a disability that may affect your use of library services	Disabilities

Contract/course Start date		Contract/course Finish date

I agree to abide by the library regulations Tick box