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BOOK CLUB MEMBERSHIP APPLICATION Book Club Name Book Club Coordinator Address bBIRTH. MALE FEMALE Phone Number Library Membership No. Email Address Meetings Day Start Time Finish Time Frequency Venue Number of Members Are you interested in potential new members Y / N We understand that each year in October our book club will need to purchase a book set of 8 titles which will be made available to all GRL registered book clubs. Purchase of these titles will need to be made in consultation with library staff to avoid duplication. Staff Use BC Membership Number COM-F-507 Date Book Club Membership Application Form 13/07/10 CONDITIONS OF BOOK CLUB MEMBERSHIP The Book Club acknowledges responsibility for all items borrowed on this membership card and for any damage to items loss of items or fines incurred. It is the responsibility of the Book Club Coordinator or nominated individual to reserve items for their book club. Each Book Club can only reserve one set at a time. The Book Club library card must be presented for all library transactions. The Book Club Coordinator is responsible for all items issued on their library card and must return the complete Book Club set. repair of the item and any associated fees. If email notification is nominated for library notices it is the Book Club Coordinator s responsibility to ensure that their email address is current to check their email and to act on notifications. I have read and understood the rules and policies set out above and agree to abide by them* Signature. PRIVACY STATEMENT Gympie Regional Council collects personal information where it is directly related to a function or activity of Council and where the collection of such information may be reasonably considered as necessary for that purpose. It will only use personal information for that purpose and will not disclose it except as permitted under the Information Privacy Act 2009. Each Book Club can only reserve one set at a time. The Book Club library card must be presented for all library transactions. The Book Club Coordinator is responsible for all items issued on their library card and must return the complete Book Club set. The Book Club Coordinator is responsible for all items issued on their library card and must return the complete Book Club set. repair of the item and any associated fees. If email notification is nominated for library notices it is the Book Club Coordinator s responsibility to ensure that their email address is current to check their email and to act on notifications. repair of the item and any associated fees. If email notification is nominated for library notices it is the Book Club Coordinator s responsibility to ensure that their email address is current to check their email and to act on notifications. I have read and understood the rules and policies set out above and agree to abide by them* Signature. I have read and understood the rules and policies set out above and agree to abide by them* Signature. PRIVACY STATEMENT Gympie Regional Council collects personal information where it is directly related to a function or activity of Council and where the collection of such information may be reasonably considered as necessary for that purpose.

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