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.

* Indicates a required field.


Contact Information
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About the Exhibit
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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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Location Exhibit will be Displayed
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Other Information
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Library
Science Center
Planetarium
Museum
Other. Please describe:  
* Please estimate your audience diversity:
*How would you classify your community?
*How would you classify the community income level?
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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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the Explore! library program
Museum Alliance
email from colleague
other (please describe)


* indicates required field.
If you see an error message, please correct and resubmit.