Institution Information
* Required Fields
Institution:
*
Library Name:
*
Address 1:
*
Address 2:
City:
*
State:
*
Zip:
*
Phone:
*
Fax:
*
URL:
FTE Count:
*
OCLC Symbol:
Parent OCLC Symbol:
Form Completed By:
First Name:
Last Name:
Phone:
Email:
*Official NELINET Representative:
First Name:
Last Name:
Phone:
Email:
*Official NELINET Billing Representative:
First Name:
Last Name:
Phone:
Email:
*Library Director/Interim:
First Name:
Last Name:
Phone:
Email:
Authorized Signature (Full Member):
First Name:
Last Name:
Phone:
Email:
Authorizing Person (Affiliate Member):
First Name:
Last Name:
Phone:
Email:
Cataloging:
First Name:
Last Name:
Phone:
Email:
Collection Development:
First Name:
Last Name:
Phone:
Email:
Serials:
First Name:
Last Name:
Phone:
Email:
FirstSearch/ECO:
First Name:
Last Name:
Phone:
Email:
InterLibrary Loan:
First Name:
Last Name:
Phone:
Email:
Library Media Specialist/Teacher:
First Name:
Last Name:
Phone:
Email:
Reference:
First Name:
Last Name:
Phone:
Email:
Union List:
First Name:
Last Name:
Phone:
Email:
Information Technology:
First Name:
Last Name:
Phone:
Email:
Acquisitions:
First Name:
Last Name:
Phone:
Email:
June 16, 2004
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NELINET, Inc., 153 Cordaville Road, Southborough, MA 01772 1.800.NELINET (tel) 508.460.9455 (fax)