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West Virginia State Archives

WVAH-01
Form #1

Library Registration Form
West Virginia Archives and History


Name ___________________________________________________________________________________

Affiliation ________________________________________________________________________________

Street Address ____________________________________________________________________________

City _____________________________________________ State ________ Zip _______________________

Home Phone ________________________________ Business Phone ________________________________

E-Mail Address __________________________________________________

DECLARATION: I acknowledge that I have received, read, understand and will abide by the Archives and History Library rules as listed. I understand that violation of the rules is grounds for revocation of permission to use the library or Archives and History materials.


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West Virginia Archives and History