New Reading Room Form with Logic

Kilby Reading Room Registration Form
Name:

First NameLast Name
Email:
example@example.com
Form Type:
Blank Space!
Form Type:
Blank Space!
Form Type:
Blank Space!
Form Type:
Blank Space!
Form Type:
I am...
Name of Proxy Researcher (if known):

First NameLast Name
Proxy Research on behalf of:

First NameLast Name
Total Number of Visitors (Including You):
Only visitors who share the same address may use the same form
Additional Visitor Names:
Address:

Street Address

Street Address Line 2

CityRegion (if outside US or Canada)

Postal/Zip Code
Country:
State:
Province
State/Region/Province

Street Address

Street Address Line 2

City

Postal / Zip Code
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Wheaton College Role:
Department/Major:
Student ID (if applicable):
Date and Time of Visit
Date of Visit:
On/From:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearFirst (or only) date of visit
To:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearLeave blank if you are only here for the day specified above.
Estimated Time of Arrival (9am to 4pm only):

Hours Minutes

AM/PM Option
Purpose of Visit
Reason for Visit (choose the option that best applies):
Proxy Research on behalf of:

First NameLast Name
Reason for Visit:
Class Professor:
Course Number (or title):
Author(s) of Interest (select any that apply):
Other:
Topic(s):
Research Topic:
Affiliation:
Affiliated Institution Name:
(if applicable)
Other Affiliation:
Institutional Role:
Other Role:
Department:
What Graduate Degree Are You Pursuing?
Ex: M.A., Ph.D., M.Div., Psy.D., etc.
Research Questions/Area of Study:
Is your research project intended for publication?
Proposed Title of Publication:
*Expected Date of Publication:
*or date of completion for theses/dissertations
User Agreement
The Marion E. Wade Center permanently retains all data provided on this form, as well as records pertaining to requested materials. This data is only accessible by Wade Center staff.
I agree that typing my name constitutes my digital signature:

First NameLast Name
Form Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearToday's Date
Should be Empty:

Kilby Reading Room Registration Form

Date and Time of Visit

Purpose of Visit

User Agreement