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2006 - 2011 New MCR Affiliate Member Agreement Form

New Affiliate Member Institution Information

Please fill in the below fields. Note that the fields marked with an * are required.

*Library Name:
*Institution Name:
*Mailing Address:
*City:
*State:
*Zip:
*Affiliate Member Contact:
*Email:
*Phone:

New Affiliate Member Institution Certificate

How would you like your library and/or institution's name to appear on the certificate?

Please provide up to four lines of text. Each line can be a maximum of 35 characters (including spaces) long. This usually is some combination of the name of the library and/or your institution. Enter the name of your library and/or institution only: do not enter your address.

Note that the field marked with an * is required.

*Line 1:  (35 Characters maximum)
Line 2:  (35 Characters maximum/optional)
Line 3:  (35 Characters maximum/optional)
Line 4:  (35 Characters maximum/optional)

Please take a moment to review the mission of the National Network of Libraries of Medicine (NN/LM) and responsibilities of an Affiliate Member.

Mission

The mission of the NN/LM is to advance the progress of medicine and improve the public health by: 1) providing all U.S. health professionals with equal access to biomedical information; and, 2) improving the public's access to information to enable them to make informed decisions about their health. The Program is coordinated by the National Library of Medicine and carried out through a nationwide network of health science libraries and information centers.

Responsibilities

Affiliate Member Instituions must agree to make the following contributions:

  • Designate an individual as the local contact person for network information/communications.
  • Agree to establish and maintain with my state liaison my membership record (or Institutional Record) within the NN/LM's national online directory of members;
  • Provide basic information on collections and services.

By pressing the "submit" button below, you knowlege that you are authorized on behalf of your institution to request membership with the National Network of Libraries of Medicine and that your institution agrees to meet the responsibilities of an Affiliate Member with the National Network of Libraries of Medicine.


If you have any question regarding this form, please contact John Bramble via email at jbramble@lib.med.utah.edu or by phone (800) 388-7657 (then dial when prompted 1, then 2, then 6) or his direct line at (801) 585-5743