Research Library Form

Reader's ticket application

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The information you are asked to provide to the Gallery is personal information and is protected by the Privacy Act 1988. The Gallery collects your personal information to maintain your application for a Reader’s Ticket. The Gallery will not disclose this information to other parties other than in accordance with the Privacy Act 1988.

Applicant's Details

Full Name required

Email address required

Phone required

Fax

Postal address

Institutional Affiliation
If appropriate please indicate whether
staff or student. If student, please
give details of course, year.

Purpose of Request

Applicant's Signature

Referee's Details

Full Name

Position

Date

Referee's Signature

Please Send/Fax this form to:

Chief Librarian
NGA Research Library
GPO Box 1150
Canberra ACT 2601 Australia

fax:+61 2 6273 2155
phone:+61 2 6240 6532