Special Collections

Thesis Request Form

For Libraries Requesting a Copy to be Included in Their Collection

COPYRIGHT DECLARATION
Date of declaration
Fill in all sections, print the form and sign the declaration. Ensure that the ordering details are completed.
Fill in a separate form for each thesis copy.
To: Special Collections Officer, Information Services, The University of Melbourne
Please supply me with a copy of the following thesis in accordance with S49of the Copyright Act 1969 - 1980. I understand that permission from the author may be required and delays may be incurred.

Author
Title
Degree Conferred
Date Conferred
   
 
Name
Postal Address
Photocopy will be sent to this address
Contact Number
Email Address

 

Signed     __________________________________________ 

THESIS REQUEST FORM
Please fill in a separate form for each thesis copy
I wish to request: 
    Unbound photocopy - A$100 per volume - If supply is within Australia, add $10 GST (Includes postage within Australia)    
    CD ROM - A$100 per volume - If supply is within Australia, add $10 GST (Includes postage within Australia)    
    URGENT - Add A$15 handling fee - If supply is within Australia, add an extra $1.50 GST
    Express Post (within Australia only) - add $9.90 GST inc
    
    Overseas Airmail - add A$15
Total cost

Method of payment       Please check one box
    Cheque made payable to 'The University of Melbourne'      Visa
    Mastercard   
Cardholder Name
Cardholder Number
Expiry date
Receipt required

   
Billing Address
Receipt will be sent to this address		  
Name
Address
 
 
 
Contact Number
Email Address

Please fill in all sections, print the form, sign the declaration and either: 

Fax to: +61  3  9347 8627 
or 
Send to:
Special Collections
Baillieu Library
Information Services
University of Melbourne
Victoria 3010
Australia

For thesis queries:
Telephone: (03) 8344 5997
Email: special-collections@unimelb.edu.au
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