NETWORKS for Training and Development, Inc.
      
      COMMUNICATION MENTORS LIBRARY LOAN FORM
      


ITEM NAME __________________________________________________________________________

PUBLISHER/AUTHOR/MANUFACTURER _________________________________________________

CIRCLE ONE:	BOOK 	 CD/DVD	VIDEOTAPE	AUDIOTAPE	AT/AAC DEVICE

DATE BORROWED ______________________	DATE DUE ______________________ (2 wk. max.)

BORROWER’S NAME __________________________________________________________________

ORGANIZATION ______________________________________________________________________

ADDRESS ______________________________________________________

	     ______________________________________________________

PHONE # /EMAIL______________________________________________________________________

SUPERVISOR’S NAME/PHONE #_________________________________________________________

BORROWER’S SIGNATURE ____________________________________________________________

NETWORK’S STAFF SIGNATURE _______________________________________________________

? YELLOW COPY TO BORROWER AND ORIGINAL TO LIBRARY “OUT BOX”   ?

PLEASE NOTE THAT THE MENTORS LIBRARY IS ONLY FOR GRADUATES OF THE COMMUNICATION MENTORS’ COURSE.  THERE WILL BE A FEE CHARGED FOR ANY ITEMS NOT RETURNED: DEVICES & BOOKS – REPLACEMENT COST; VIDEO/AUDIOTAPE - $25.00

PLEASE RETURN MATERIALS TO “IN BOX” WITH ORIGINAL FORM SIGNED AS RETURNED OR BY MAIL TO:
COMMUNICATION MENTORS COORDINATOR
NETWORKS FOR TRAINING AND DEVELOPMENT, INC.
1220 VALLEY FORGE ROAD, UNIT 17
PO BOX 206
VALLEY FORGE, PA 19481-0206