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RRLC Access Pass Request

This form is for patrons at SUNY Brockport to request an RRLC Access Pass. For more information and a printable version of the form, see: RRLC Access Pass

  • Name Name *
  • Must be 9 characters.   Currently Entered: 3 characters.
  • Status *
  • Card Delivery:
    Card Delivery:
  • Home Address Home Address
  • Phone Phone * - -
  • Rules and Regulations -- Signature Required

    By submitting this form you agree that:
    1. Each RRLC Access Card is non-transferable and can only be used by the person to whom it is issued.
    2. Use of the RRLC Access Card is subject to the rules of each participating library.
    3. Replacement costs for lost or damaged materials must be paid by the person whose signature appears on the card.
    4. Overdue fines are payable to the lending library by the person whose signature appears on the card.
    5. The card does not give automatic entrance to participating libraries. Borrowers must check hours and requirements for appointments of participating libraries.
    6. Lending libraries may restrict access to certain categories of Access Card holders.
    7. Cards are valid for a maximum of one year, from July 1 to June 30, with no automatic renewal.

  • Draw or Type
    I understand this is a legal representation of my signature. Clear
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