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Access Form

To become a Collection Access Cardholder or to renew your access, please fill in this form, sign it, and return it with a copy of your identification, concession ID (if applicable) and payment.

All individual applicants need to provide identification, such as a copy of a driver's licence or a household bill with their current address. Concession holders need to provide a copy of either their Senior's Card, healthcare card or a student card.

You can fill in this form online - type directly into each box, then print it out - or you can print it out and fill it in by hand. If you have any difficulty using this form, you can contact collections on (03) 8663 2467 between 9am and 5pm, Monday to Friday (AEST).

Send to:

ACMI Collections
PO Box 14
Flinders Lane
Melbourne, Victoria 8009

       

ACMI respects your privacy.

Your Details
Title
First Name
Last Name
Organisation
Department
Access Card No. (if renewing)
Address
(please ensure identification
is attached)
 
Suburb
State
Postcode
Telephone
Alternative Telephone
Mobile
Facsimile
Email

 

(correspondence will be via email if you provide an address)

Your Interests
(complete only if new application)
The following information assists us to identify areas of interest as we expand the collection.
What is your age? 
Which of the following types of film genre interest you (Tick all relevant boxes)  Feature films
Foreign films
Documentaries
Television programs
Children's films
All
Where did you first hear about the collection? 
Are you currently enrolled in a Cinema Studies Course?  Yes   No 
Do you wish to borrow 16mm films?  Yes   No 
If yes, please complete a 16mm Application Form and return it with this form.

Yearly Access
 
Regional Access
Full - $105
Access to up to six titles per fortnight.  
Concession -  $80
Entitles access cardholders with concession (valid seniors, healthcare or student card) up to six titles per fortnight.
Schools
Basic access - $156
Entitles the school up to four titles per week (metropolitan) or six titles per fortnight (regional).
Note that while collections provides outward freight direct to schools, all return freight is the responsibility of the access cardholder.
 
Special access - $235

Entitles the school up to eight titles per week. Provides extra 'schools-only' benefits, including regular newsletters, an individualised catalogue on a topic of choice and an extra fine waiver each year.

 
Organisations
Non-profit organisations (community groups, film societies, etc.) - $130
Entitles the organisation up to four titles per week (metropolitan) or six titles per fortnight (regional).  
Commercial organisations and tertiary institutions - $260
Entitles the organisation up to four titles per week (metropolitan) or six titles per fortnight (regional).  

Payment Details
I wish to pay by cheque and enclose a cheque for the amount of
  or
Please debit my credit card for the amount of
Credit Card Details
Name of Cardholder
Card Type Visa    Mastercard    Bankcard 
Card Number    
Expiry
Date
 
Signature _________________________________

Collection and Returns
Collect from the following public library:
Eligible for outward freight (schools only)  
Please read the access - conditions of loan before signing this form.

Declaration
I have read and understand the access - conditions of loan, including the Copyright information, and understand that failure to observe these conditions may result in the cancellation of my access.
Date
 
Signature _________________________________

 
 
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