Pragda | Library Subscription Order Form

SCHOOL INFORMATION (*Required)
Select*
First Name*
Last Name*
Title*
Department*
School*
Street Address*
Address Line 2
City*
State / Province / Region*
ZIP / Postal Code*
Phone*
Fax
Email*
Website*
University EIN#
MEMBERSHIP (*Required)
Select the level of Membership you are interested in*
Select the payment method of your preference*
TELL US MORE ABOUT YOUR SCHOOL (*Required)
Is this school a public or private institution?*
How many students attend the University?*
What is the most popular genre among your students and professors?*
Where did you learn about Pragda's Library Subscription service?*
MEMBERSHIP APPLICATION AGREEMENT

I, the applicant, hereby certify that the information contained in this membership application is true and correct.
Your Complete Name*

Enter your name to serve as a digital signature certifying the authenticity of your order.
Your Initials*

Enter your initials to serve as a digital signature certifying the authenticity of your order.
Title