Library Membership Transfer Handover Certificate Form
Certificate for transferring library membership between members or responsible parties.
Outgoing Member's Full Name
*
First Name
Last Name
Outgoing Member's Email Address
*
example@example.com
Incoming Member's Full Name
*
First Name
Last Name
Incoming Member's Email Address
*
example@example.com
Library Membership Number or Reference
*
Date of Membership Transfer
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Transfer (optional)
Outgoing Member's Signature
*
Incoming Member's Signature
*
Library Staff/Witness Name and Signature
*
Submit Certificate
Submit Certificate
Should be Empty: