User Registration Form

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To use the Henderson State University Archives, all researchers must read the Archives Rules & Procedures, and complete and submit this one-time User Registration Form.

Name__________________________________________________

Home Address___________________________________________

Home Phone_____________________Work Phone______________

Email Address___________________________________________

User Type:

_____HSU Faculty _____OBU Faculty _____AR State Govt.

_____HSU Staff _____OBU Staff _____AR County Govt.

_____HSU Student _____OBU Student _____Municipal Govt.

_____Public _____Other _____Federal Govt.

Intended Use:

_____Article/Book _____Personal Interest

_____Records Management _____Work related/Professional

_____Exhibit _____Thesis/Dissertation

_____Family History/Genealogy _____Government Business

_____TV/Video/Film _____Class Assignment

_____Lecture/Presentation _____Other

By signing this form, you acknowledge that you have read the Henderson State University Archives Rules & Procedures and agree to abide by the state.

Signature ____________________________Date_________________