NLSI Moon Exhibit Request
Request for the Loan of a Specific Exhibit
I have read and agree to the
Loan Guidelines
After we receive your request, we will respond within 10 business days. We will later send you the link to the
online loan agreement
within 1-2 months before the period of the loan. Please fill it out within 10 business days of receiving the email request from us.
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Indicates a required field.
Contact Information
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First Name:
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Last Name:
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Organization:
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Address(1):
Address(2):
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City:
* State:
* Zip:
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Telephone:
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E-mail:
About the Exhibit
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Name of Requested Exhibit:
The Moon: Cosmic Decoder Ring
Treasure Hunt in Earth's Attic
Earth's Daughter
Impacts: Delivering Death and Fostering Life
Moon Views
Storm of Asteroids
Molten Moon
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Preferred Beginning Date for Exhibit Display:
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Preferred Ending Date for Exhibit Display:
Alternate Contact
Please provide an alternate contact, in the event that you are away when we ask you to fill out the online loan agreement.
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Name:
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Email:
Location Exhibit will be Displayed
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Name of Building:
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Street Address:
Room Name or Number, if any:
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City:
* State:
* Zip:
Other Information
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Type of Organization:
Library
Science Center
Planetarium
Museum
Other. Please describe:
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Please estimate your audience diversity:
% Hispanic
% African
American
% Caucasian
% American
Indian
% Asian
% Other
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How would you classify your community?
Rural
Urban
Suburban
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How would you classify the community income level?
upper
upper-middle
middle
lower-middle
lower
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Do you plan to have other activities related to the exhibit display? If so, what? (e.g. related resource display, family programs, childrens' programs, night viewing ...)
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LPI has very little funding currently to support shipping the exhibits. Please select which way you would like to cover the shipping:
I will provide credit card information in the online loan agreement that will be charged $100 to help cover shipping costs.
I will provide my organizations FedEx account information for LPI to use to ship the exhibit to me. I understand that LPI cannot estimate what my shipping charges will be.
I will pick up and return the exhibit in person.
My organization is financially unable to support the shipping costs for this loan request.
Please provide additional information regarding your need:
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How did you learn about these traveling exhibits?
the Explore! library program
Museum Alliance
email from colleague
other (please describe)
Questions/Additional Information?
* indicates required field.
If you see an error message, please correct and resubmit.