LSAH 8pp - Library of Birmingham

Application Form for Membership
We are keen to build a database of members
of Library Service at Home. The following
information will be used to help us plan our
services. Please fill in your details, which will
only be used by the council.
Name .................................................................
Address ..............................................................
...............................................................................
...............................................................................
Postcode ............................................................
Telephone ..........................................................
Date of Birth .....................................................
Ethnic Origin (Please tick box)
White
o British
o Irish
o White Other
Mixed
o White & Black Caribbean
o White & Black African
o White & Asian
o Other Mixed
Asian or Asian British
o Indian
o Pakistani
o Bangladeshi
o Other Asian
Black or Black British
o Caribbean
o African
o Other Black
Other Groups
o Chinese
Other (please specify) ................................................
o Do not wish to give this information
In compliance with the Data Protection Act
1998, all information will be kept secure
and treated confidentially. It will not be
passed to other organisations without your
permission.
Emergency Contact Name / Telephone No.
..........................................................................
I am unable to get to the Library because
..........................................................................
.........................................................................
Please complete the form, detach from
the leaflet, put it an envelope and post
to the address below.
You will be contacted soon.
!
Library Services at Home
Library Services at Home
Unit 14, Gravelly Industrial Park
Tyburn Road, Erdington
Birmingham B24 8HZ
We can supply the following
l
Ordinary Print Books
l Large Print Books
l Books in community languages
l Talking Books (on cassette and CD)
l Jigsaws
l Magazines
l Music
l Community Information Leaflets
Library Services
at Home
in Birmingham
To apply to join Library Services at Home,
simply complete the application form
opposite and send it to the address shown.
Library Services at Home
Unit 14, Gravelly Industrial Park
Tyburn Road, Erdington
Birmingham B24 8HZ
If you would like more information or you
would like this text in a different format,
call Library Services at Home on
0121 464 1118
www.birmingham.gov.uk/libraries
Information Leaflet
& Application Form
Library Services at Home is
a free service which takes
books and other library
materials to people who
find it hard to get out of
their homes without help.
Which of the following do
you require?
The service is provided by
Birmingham Libraries.
A monthly supply of books and
equipment can be delivered to
your door by a member of library
staff, who can also advise you on
how to get the best out of the
service. We also offer a free
reservation service if there is
something particular you want.
If you would like more
information, telephone one of our
staff on 0121 464 1118
Ordinary Print ............. o
Large Print ..................... o
Cassettes ....................... o
CDs .................................... o
Are you registered blind?
YES o
NO o
How did you hear of our
service?
Which of these
subjects interest you....
family sagas ........... o
romances ................ o
detective stories ....o
historical fiction .....o
science fiction ....... o
adventure stories .. o
biographies ............. o
non-fiction ............. o
other .................................
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Please complete application
form overleaf