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: