Self-serve photography application

Download the print version
PDF document, 4.63 MB, 1 page)

Please complete the form below and bring it to the consultation desk for validation.

We will make a green copy for you.

Personal information
Name	First name:User can enter their first name in this location	Last name:User can enter their last name in this location
User card number	User can enter their 14-digit user card number in this location
Authorization period	From:User can enter their requested authorization "from" date in this location	To:User can enter their requested authorization "to" date in this location

List of items you'd like to photograph

Shaded fields to be filled out by staff.

Item number	Reference No.	Restrictions (contractual or ATIP only)	Verified by
1.	Reference number	Any restrictions	Name of staff member who verifying this information
2.	Reference number	Any restrictions	Name of staff member who verifying this information
3.	Reference number	Any restrictions	Name of staff member who verifying this information
4.	Reference number	Any restrictions	Name of staff member who verifying this information
5.	Reference number	Any restrictions	Name of staff member who verifying this information
6.	Reference number	Any restrictions	Name of staff member who verifying this information
7.	Reference number	Any restrictions	Name of staff member who verifying this information
8.	Reference number	Any restrictions	Name of staff member who verifying this information

Users agree not to use records from LAC collections in a manner that would infringe on the rights of others.

Signature block
Signature:Signature location	Date:Date location