Library Enrolment Form

Welcome to the Association for the Blind of Western Australia - Guide Dogs WA digital Talking Book Library services. Use this form to signup for our download service only. For our postal library service within Western Australia please contact the Association on (08) 9311 8202 or toll free on 1800 847 466. You may also download a blank version of this form as a PDF file.

Under the Australian Copyright Act of 1968 as amended person who are blind or vision impaired, dyslexics and those with physical impairment which prevent them from reading or handling conventional printed materials are entitled to revive from the Association's library service recorded books and other reading matter. Similar provisions are found in the copyright laws of most other nations as well.

Please complete the form below and then press the Generate Print Form button. This will take you to a filled out version of this form which you may then print out and have signed by a certifying authority. People who are blind or vision impaired may send us a photocopy of their Blind Citizens of Australia ID Card or state transit pass as proof of disability. Alternatively you will need to have the certification of disability signed and then fax or mail this form to us.

Certifying authority:

Certifying authority includes doctors of medicine; doctors of osteopathy; ophthalmologists; optometrists; registered nurses; therapists; and professional staff of hospitals, institutions, and public or private welfare agencies (e.g., social workers, case workers, counsellors, rehabilitation teachers, and superintendents) teachers, school principals, school councillors and other educational professionals, ministers of religion, postal clerks, police and other civic officers. In the absence of any of these, certification may be made by professional librarians or by any person whose competence under specific circumstances is acceptable to us.

Personal Information First name:
Last name:
Address:
City:
State:
Postal Code:
Country:
Email:
Phone:
Nature of print disability:

Parent/Guardian Signature

The person named above is a minor child a signature of a parent or guardian will be provided.

Signature: Date:

Certification

Please provide a copy of any of the following items:

A Blind Citizens of Australia ID card
A state or territory transit card
Other disability identity card
Mailing label or card from your national or regional talking book library (both sides)
These cards are commonly used to address books to you from your library.

OR

Request that your national or regional talking book library email a statement to us at dtb@guidedogswa.com.au stating that you are enrolled with them. If they refuse to do so please email to us the whole exchange including your original request and their reply to you. We will use this exchange as proof of disability.

OR

I certify that the applicant named above is requesting library service and is unable to read or use regular printed material for the reason indicated on this form.

Please Note: This section must be signed by the certifying authority spoken of above.

Signature: Date:

Title (Dr. etc.):
First name:
Last name:
Address:
City:
State:
Postal Code:
County:
Email:
Phone:

Notes

Challenge Question Please provide the correct answer to the following question. What is the sum of: One plus Eight?

The button below will generate a page that can be printed. You can use this page to collect the required signature and fax, post or email a scan of it to us.

Contact Details

Library Enrolment Form

Certifying authority:

OR

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