Interlibrary Loan Request Form

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Medical Library

Interlibrary Loan Request Form

NOTICE CONCERNING COPYRIGHT RESTRICTION

The copyright law of the United States (Title 17, United States code) governs the making of photocopies or other reproductions of copyrighted material, under certain conditions specified in the law. Libraries and archives are authorized to furnish a photocopy or other reproductions; however, the reproductions are not to be "used for any purpose other than private study, scholarship, or research." If a user makes a request for, or later uses, a photocopy or reproduction for purposes in excess of "fair use" that user may be liable for copyright infringement. This institution reserves the right to refuse to accept a copyright order if, in its judgment, fulfillment of the order would violate copyright law. Please Indicate that you have read this warning and that you are complying with the U.S Copyright Law by stating your identity in the box below:

1. Your Name: This serves as your digital signature. NOTE: Interlibrary Loan request will not be filled without a copyright notice signature.

2. Your background / affiliation with ETSU:

3. Please fill out the following section:

Department:

Phone Number:

E-Mail Address:

Mailing Address (Non-Affiliated):

4. Journal Information:

Please Include PubMed Identification Number (PMID) if known.

Journal Title:

Year:

Volume:

Issue:

Page Number(s):

PMID Number (if known):

Author(s) (if known):

Article Title (if known):

5. Book Information:

Book Title:

Author(s) (if known):

Date Published:

Edition:

Pages/Chapter/Title:

ISBN (if known):

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