Connecticut Clearinghouse
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Membership Form

Connecticut Clearinghouse
Membership Benefits

Membership is open to anyone who lives or works in Connecticut. Members may borrow the following items for 3 weeks, with an option to renew one time.  Library materials can be shipped within Connecticut to members unable to visit Connecticut Clearinghouse.

  • 6 books/curricula
  • 3 DVDs

Pamphlets, posters and fact sheets are available to members.

 Materials may be returned to Connecticut Clearinghouse:

  • in person
  • placed in the return box located near the front door
  • via insured US mail, UPS, or carrier of choice (Insure DVDs for $100 each)

Scroll down to fill out the online form.  If you prefer to send your membership via mail or fax follow the link below:
Mail or Fax Your Membership Form  

Connecticut Clearinghouse Membership Agreement

I agree to assume full responsibility for all audiovisual materials, curricula and books borrowed from Connecticut Clearinghouse and to pay for the loss or theft of, or damage to, said materials while in my care; the amount of payment to be determined by the lender.

I agree to pay overdue fines of 10¢ per day for each overdue book and 50¢ per day for each overdue audiovisual.

I understand that Federal law provides severe and criminal penalties for the unauthorized reproduction, distribution or exhibition of copyrighted audiovisual materials.  I also understand that the staff of Connecticut Clearinghouse reserves the right to suspend or terminate my membership if I violate the terms of membership as stated in this agreement.

Send Materials to (Connecticut address required):

Please tell us about yourself: (* denotes required fields)

First Name *
Last Name *
Job Title
Business Name
Business Address
State * Zip
Home Address *
City *
State * Zip *
Phone *
Email *
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Payment Information: (* denotes required fields)

Pay by Credit Card Type of card: * Visa   Mastercard
Card Number: *
Expiration: * (MM/YYYY)
3 or 4 digit security #: *
Pay by Check Mail a check in the amount of $10 payable to Connecticut Clearinghouse (Membership will be processed upon receipt of payment.)

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