Form A

The Thomas Merton Center at Bellarmine University

2001 Newburg Road, Louisville, Kentucky 40205-0671

REGISTRATION for Use of Materials in the Thomas Merton Collection

Name (Print)_______________________________________________________________________

Permanent Address_________________________________________________________________

Telephone (O)________________ (H)________________ Email: _____________________________

Local Telephone No. in Louisville______________________________________________________

Affiliation_______________________________________ Status____________________________

PURPOSE OF STUDY: Book _____ Periodical Article _____ Dissertation, Thesis __________________

Other ___________________________________________________________________________

Topic of Focus of Study:_____________________________________________________________

Describe on the reverse of this Registration sheet the Merton archival materials you are requesting to inspect, to take notes upon and/or to have reproduced.

Photocopy Form of Picture I.D. in the space provided below:

I have read the regulations that govern the use of the Merton archival materials in the Thomas Merton Center and I hereby apply for permission to read and take notes from the materials listed on the reverse of this application.

I acknowledge that permission to examine Merton archival material is granted for reference purposes only. Permission to examine DOES NOT INCLUDE permission to REPRODUCE or PUBLISH the material consulted by me.

I acknowledge that permission for copies of photographs or any other reproduction may be granted but FOR REFERENCE PURPOSES ONLY. Reproduction costs are to be paid in advance by me.

I acknowledge that permission to publish in any form, all or any part of the material I have reproduced, must be obtained in writing from the Merton Legacy Trust.

Signature________________________________________ Date_____________________