Registration and Copyright Declaration for Electronic Requests

This form must be returned to the library's Distance Learning Services Office before Electronic Requests will be processed. This form must be completed and submitted at the beginning of each academic year.

If you wish to pick up your Library card in person, it is available at the Circulation Desk.

After printing and completing this form, mail or fax it to:

Distance Learning Library Services Office
WPI
George C. Gordon Library
100 Institute Road
Worcester, Massachusetts 01609-2280
FAX: (508) 831-5829

I understand that all documents requested by me electronically are subject to copyright restrictions, as per U.S. Copyright Law of 1976, Section 108 and WPI's Copyright Compliance Policy.

I agree to abide by the regulations of the Act for all such items as witnessed by my signature below.

Name:	___________________________________________
Address:	___________________________________________
	___________________________________________
Telephone:	____________________
FAX:	____________________
Email:	__________________________________
WPI Department:	__________________________________

Signature:	___________________________________________
Date:	____________________

Staff Use Only

Gordon Library Patron:	#______________________
Library card picked up:	_______________________

Maintained by lib-webmaster@wpi.edu
Last modified: Aug 09, 2005, 10:03 EDT