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U
NITED
S
TATES
H
OLOCAUST
M
EMORIAL
M
USEUM
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.