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CLACS Media Collection
User's Agreement

If you are a new user, you must complete and return this form
before borrowing materials from the collection.

By completing and signing this User's Agreement, you, the patron, agree to follow all regulations outlined in the loan policy. Incomplete forms will be returned and materials will not be shipped until a complete form is returned and on file. Required sections are marked with an asterisk (*).  PLEASE PRINT CLEARLY.

I, _____________________________________________________ *(full name), certify that I teach at ________________________________________________________* (name of institution) and that I have read and agree to abide by the Media Collection Policies. Any materials I borrow will be used for classroom or research purposes only and will not be duplicated or shown in any public setting.

School / Institution Address*                             Home Address

_____________________________________     ____________________________________

_____________________________________     ____________________________________

_____________________________________     ____________________________________

School Phone:* (        ) ______ - _________       Home Phone:(        ) ______ - _________

Email:* _______________________________________________________________

Official UPS Shipping Address*:
This address is for shipping via UPS. Be careful to provide an actual street address or one that is acceptable to UPS standards. Contact us with questions or problems.

____________________________________________

____________________________________________

____________________________________________

____________________________________________

Signature*_________________________________________________________

Date*_________________

Please return form to:
Center for Latin American and Caribbean Studies
University of Wisconsin-Milwaukee
P.O. Box 413
Milwaukee, WI 53201