Individual Library Subscription Form
 
Once this form is submitted you must visit the Wilson Dental Library to complete processing your application. Please bring photo ID and proof of health profession status at the time you visit to pay for your subscription. (Your application information will be kept for 30 days from the date of submission.)
* Last Name : * First Name : Initial :
   
Social Security Number : Driver's License / Photo ID No. :
* E-mail address : CA Driver's License
Other :
 
Address 1 (Permanent Local Address) :
* Number and Street Name : Apartment / Condo / Suite No. :
   
* City and State : * Zip Code :
   
* Home Phone Number :
* DDS Other :
 
Address 2 (Business Address / Employer's Name) :
Company Name : Title :
   
Number and Street Name : Room / Suite No. :
   
City and State : Zip Code :
   
Business Phone and Extension :  
 
* Required information
By submitting this form I understand that there is a non-refundable fee ($60.00/six months or $100.00/one year). I agree to comply with the non-use of the Soule Computer Learning Center, non-use of the library's personal computers and printers, and I further agree to comply with the other rules and regulations of the USC Wilson Dental Library as given in the "Fee Library Card - Personal Use" document and as described in the written policies of the Wilson Dental Library, the Health Sciences Libraries, and the University. I also agree not to give or loan my library card to another person and that I will not loan or share borrowed USC library material with any non-USC library card holder(s) or non-USC fee card individual(s).
 
* I agree. Yes