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Arizona Health Sciences Library
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Arizona Health Sciences Library
Registration Form
for AHSL Community Card
Eligibility for AHSL Community Card: Must be a resident of Arizona. Arizona health professionals are given additional benefits if proof is provided. Please inquire if you are interested in a Corporate Card.
    *
Indicates a required field
* Your name
(Please include full namE: first name, last name and full middle name if available)
* Home
address
* City, State, ZIP
* Home phone number Day  Eve.
(Please include area code)
  Employer/ business
address
  City, State, ZIP
   
Work/ business phone number Day  Eve.
(Please include area code)
E-mail
*

Please provide information:

Health Professional

License or certification type & number:
       

Resident of Arizona

AZ License number:
       
            

* Payment Information

There is an annual fee of $60 for the AHSL Community Card. Please indicate how you wish to pay:

I will call (520-626-4398) or fax (520-626-2831)with my Visa or MasterCard account name, number and expiration date. (This is not a secure site--do not send credit card numbers in this form)

I will mail my check with a printed copy of this form to the address below.

Please send me an invoice for $60.00.

Once payment is received, allow 1-2 days for processing your registration.

Loansome Doc I am registered with Loansome Doc, the document delivery service sponsored by the National Library of Medicine.
Additional Comments:
   
By sending this AHS Community Card registration, I acknowledge responsibility for all library materials checked out on my card and for all Interlibrary Loan fees that I may incur.


For assistance or comments,
email Javad Basij or call 520-626-4398

Please print off this form and mail it with a check to:
Loan Services
Arizona Health Sciences Center
1501 N. Campbell Avenue
P.O. Box 245079
Tucson, AZ 85724-5079

Return to AHSL Community Card page