SNJPC: Video Reservation Form

Media Library Reservation Form

If you are interested in reserving literature or videos, please fill in the form below. Use the number associated with the title in the form (e.g. use #815 to reserve Preterm Labor)



Your name           
Your organization    
Your phone          
Title #1            
Title #2            
Title #3            
Title #4            
Title #5            
Title #6            


Pick up arrangements: (Date and approximate time)





   Select when you are finished

 Select to clear all fields

Notice to Borrowers: The agency or individual borrowing the video tape(s), presentation(s) or program(s) is responsible for returning the item(s) on time and in working condition. The agency or individual borrowing the item(s) agrees that if the item is lost or damaged, the responsible agency or individual will replace the item(s) or reimburse the Cooperative for the cost of the item(s).