NOTE: This application for for location-based access to the CSC Sex Worker Media Library at the Center for Sex & Culture in San Francisco. Please submit this form with the 'submit' button below, which is our preferred method. If you don't receive an email receipt, or if you have trouble click here to download an MS Word document to fill out and email or mail the form. If you submit the form through this web page, you should receive an email confirming your entry. Visit the Center for Sex & Culture at: www.sexandculture.org

Applicant Contact Information:

First Name:


Last Name:

Title (Ms., Mr., Dr.):

Street Address or PO Box:

City:

State or Province:

Zip or Country Code :

Phone:

E-mail (requiredl:

Confirm E-mail (required):


Project Description:

Project Budget if applicable:

University /Organization:

Department:

Organization/University Street or Mailing Address Line 1:

Organization/University Street or Mailing Address Line 2:

Organization/University City:

Organization/University State:

Organization/University Zip & Country:

Organization/University Phone:

Organization/University Dept E-mail (if applicable):

Position at Department (Professor, student, instructor, etc):

Requested Date of Appointment:

References:

Access to this library is limited. We request references from your organization, university or personal references. If you are not providing references, please comment in the optional section below.


Additional comments, optional:

 

Reference #1
Academic Supervisor or Other Reference (1):


Academic Department or Organization:

Reference (1) Phone (if applicable):

Reference (1) E-mail (if applicable):

 

Reference #2

Other Reference (2):


Academic Department, Organization or Other (2):

Reference (2) Telephone:

Reference (2) E-mail (if applicable):


If you are not able to submit this form, click here to download an MS Word document and email as an attachment or snail mail it to:

Center for Sex and Culture
Sex Worker Media Library
2215-R Market Street PMB 455
San Francisco, CA 94114

For further information or technical problems, email info (-) sexworkermedialibrary.org or call Carol Leigh at 415-751-1659