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RESEARCH REGISTRATION FORM
Members wishing to use the LAHS Library in person, please fill out and bring this form with you.


Your Name ____________________________________  Telephone (_____)_____-________

Address ______________________________________  Facsimile (_____)_____-________

City/St/Zip __________________________________  E-Mail ________________________

Identification Used ___________________________________________________________
Photo ID (Drivers License) required, attach copy

Extent of research time _______________________________________________________

SPECIFIC SUBJECT OF YOUR RESEARCH:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

MATERIALS TO BE USED: (circle those that apply)

(Photo Archives)    (Books)    (Microfilm)    (Oral Histories)    (Misc.Records)

(Other) _______________________________________________________________________

PURPOSE: (circle those that apply)

(Article)    (Book)    (College Paper)    (High School Paper)    (Genealogy)

(PHD Dissertation)    (MA Thesis)    (Film/Radio/TV)

(Other) _______________________________________________________________________

I HAVE RECEIVED, READ AND WILL COMPLY WITH ALL OF LEMONT AREA HISTORICAL SOCIETY RULES, REGULATIONS AND PROCEDURES.

SIGNED _________________________________________________________

FOR OFFICE USE ONLY:

Authorized Signature _________________________________________________Date _____________


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