Mail to: Thomas McCarthy, NYC Correction Academy, 66-26 Metropolitan Ave., Middle Village, N.Y. 113793 NYCHS RESEARCH READING ROOM REGISTRATION
1. I have read the New York Correction History Society's Rules
for the RESEARCH READING ROOM at the NYC Correction Dept. Academy in Middle Village, Queens and understand them. I agree to abide by them.
Signature _____________________________________________ Date _________________
2. Name (last) _____________________________ (first) ____________________(m.i.)____
3. Residence Address _________________________________________________________
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4. Home phone _________________________ E-mail _______________________________
5 . Affiliation (employer, college, organization) _____________________________________
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6. Affiliation address ___________________________________________________________
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7. Affiliation phone ___________________ Affiliation e-mail _________________________
8. Research topic ______________________________________________________________
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9. Circle one that applies:
a-- First-time registration
b-- Re-registration
10. Circle one that applies best:
a-- government research
b-- family history
c-- thesis/term paper
d-- backgrounding for fiction
e-- news media/documentary
f-- book
g-- other (explain) __________________________________________________
11. FOR STAFF USE ONLY: You have been assigned registration number ____________
a. Detail identifer used including ID # on card. Attach photocopy.
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b. Staff comments: ___________________________________________________
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Registered by:
Date:
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