Audio/Visual Request Form

Updated: 11/10/2003

Name __________________________________________________________

Last

First

(initial)

E-Mail Address ___________________________________________

Telephone Number _____________________________

Organization _____________________________________________

Ground Shipping Address ___________________________________
(FedEx or UPS - No POB Accepted)

_______________________________________________________

Street Address (if different from mailing address - for UPS and FedEx)

_______________________________________________________

City

State

Use a separate sheet for each month's request

Mail to:
ORA Lending LIbrary
Division of Human Resource Development
Food and Drug Administration
5600 Fishers Lane, HFC-60

Fax to:
Lending Library
Katelyn Poss 301-827-9294

I have read the policies and procedures for borrowing training materials from the DHRD Library. I agree to all the terms and conditions therein.

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