CLC Circuits Western Region Sign Up Form
Please complete the information below regarding your CLC Circuit Subscription. The subscription period is July 1, 2019 - June 30, 2020. Sign ups must be received by Friday, May 31, 2019.

More specifics about each circuit are in the chart below.

Questions? Please contact Laura Marcella, Western Region Circuits Coordinator, at lmarcella@ctlibrarians.org, or CLC Member Services at members@ctlibrarians.org or 860-344-8777.

Your Contact Information
Library *
Your answer
Contact Person *
Your answer
Email Address *
Your answer
Work Phone: *
Your answer
Choose Your Circuit Subscriptions
For each circuit, please indicate how many packets you would like to order. Your library/school/organization will be invoiced based on your responses. Please note that new subscribers are required to pay a setup fee plus annual renewal fee. A setup fee also applies to additional packets added to existing subscriptions.*

*SPECIAL - For the audio circuit, a very limited number of NEW subscribers/ADDITIONAL packets may be added without the setup fee! Save $432 per packet! Limited quantities - first come, first served.

FLIC : Foreign Language and Independent Cinema
Renewal Cost: $275 per packet; New Subscriber or Additional Packet Cost: $550 per packet (includes one time setup fee)
Your answer
Northwest DVD
Renewal Cost: $357 per packet; New Subscriber or Additional Packet Cost: $632 per packet (includes one time setup fee)
Your answer
Southwest DVD
Renewal Cost: $357 per packet; New Subscriber or Additional Packet Cost: $632 per packet (includes one time setup fee)
Your answer
Western Region Audio Book
Renewal Cost: $467 per packet; New Subscriber or Additional Packet Cost: $899 per packet (includes one time setup fee)*
Your answer
Billing
Invoices will be sent out based on your responses above.
Billing Contact Name *
Your answer
Billing Contact Email *
Your answer
Billing Contact Phone Number *
Your answer
Billing Contact Address *
Please Include: street address, City and Zip
Your answer
When would you like the invoice to be dated? *
Purchase Order
If you will be using a P.O., please provide P.O. number if you have it.
Your answer
Do you have any questions or comments?
Your answer
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