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I agree to return items borrowed in good condition in allotted time. I will be responsible for any repair or replacement costs. Loan periods are two weeks for VCR tapes and 30 days for all other items. Only two VCR tapes may be borrowed at a time. A VCR tape is considered one item and may be listed on the form with books and Quarterlies. Please contact the Library if you have not received your request or a waiting list notification within four weeks of the original request. I enclose correct postage in check or money order: $3.30 for a single item (or up to three Quarterlies), $4.30 for two, and $5.30 for three (fees are doubled for Canadian shipments). Make your check payable in US funds to “SMDPA”.

Name: _______________________________________________

SMDPA#: ____________________________________________

Home Telephone: ______________________________________

E-Mail: ______________________________________________

YOUR SMDPA MEMBER NUMBER & HOME PHONE NUMBER ARE REQUIRED FOR ORDERS TO BE FILLED