Consultation form

Name:*  
Surname:*  
Date of birth:
Reader pass / Student number:
E-mail address*:    
Phone:
Address:
Street and number:*  
Postcode and town:*  
Country:*  
Occupation:*  
Employer:
Student:* 
Date of visit:*  
Items to consult:*  
Purpose of visit:*  
Questions/Remarks:
The Ruusbroec Institute Library, erna.vanlooveren@uantwerpen.be, collects this data solely for the registration of consultations of items from the special collections. Under no circumstances will these details be given to third parties. If you want to change your personal details or have them removed from our database, please inform us using the address above. More information about our privacy policy: www.uantwerpen.be/disclaimer.