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UNITED STATES HOLOCAUST MEMORIAL MUSEUM
OUTGOING LOAN APPLICATION


* denotes required fields

BORROWER INFORMATION:
* Institution:
* Address:

* City:
State: Zip:
* Country:
Telephone:
Fax:

* Contact first name:
* Contact last name:
Title:
* E-mail:
Telephone:

* Name of exhibition:
* Display dates:
* Loan dates:
* Synopsis of Exhibition:

* Will images of the objects be required? Yes No
If yes, what format will be required?

* Do you have a facility report? Yes No
If yes, please mail or e-mail a copy. If no, a standard facility report is available from the American Association of Museums at www.aam-us.org/bookstore/detail.cfm?id=592.
* Do you have a fine arts insurance policy? Yes No
* Are you a non-profit, educational institution? Yes No
If no, please describe?

* Will the object be part of a traveling exhibition? Yes No
If yes, please list all venues. Facility reports for each additional venue will be required.

* Please describe the gallery where the loan will be displayed.