| ACM Book # | Title | Date borrowed |
| __________ |
____________________________________________________________________________________ |
_____________ |
| __________ |
____________________________________________________________________________________ |
_____________ |
| __________ |
____________________________________________________________________________________ | _____________ |
| ___________________________________________ | _____________ | |
| Printed Name of Borrower |
Date |
|
___________________________________________ |
| Signature of Borrower |
|
____________________________________________ |
| Email Address |
|
_________________________________________ |
_________________________________________ |
______ |
_____________ | |||
| Mailing Address | City | State | Zip code |
|
____________________________________________ |
| SFSU STATE ACM Officer Signature |