Today’s Date ________________ Return by _________________

Individual Mid-State UMW Library Checkouts

NAME: _________________________________________________________

ADDRESS: _________________________________________________________

_________________________________________________________

PHONE: _________________________________________________________

E-MAIL: _________________________________________________________

UMW Unit: _________________________________________________________

Book Title: _________________________________________________________

Circle Copy #: 1, 2, 3, 4

Book Title: _________________________________________________________

Circle Copy #: 1, 2, 3, 4

Today’s Date ________________ Return by _________________