Affiliate Account Request For Health Sciences Libraries

First Name*

Last Name*

Please use lowercase only!

Email Address*

Confirmation EmailProfessional Email Only- no gmail, yahoo, etc.

UC Health Work Location

UC Health Department*

Position*

Work/Office Phone Number*

Please enter a valid phone number.

Are you renewing an existing account, or creating a new account?*

RenewalNew Account

Please list your previous account number

Agreement

All materials borrowed under this agreement must be returned at the expiration of their loan period or renewed.
Any damages from misuse or loss due to theft or neglect will result in charges to you for all damages or replacement of the material.
Materials will be billed at their full current market value plus a processing charge.

Your submission confirms that you understand that these library privileges are for you and you only and that you will abide by the lending rules and regulations of all the University of Cincinnati Libraries.

Please verify that you are human*

Prefix

RanNum

Your Affiliate Number

Affiliate Login

Name

First NameLast Name