CLSE Lunar/Asteroid Traveling Exhibit Request
Request for the Loan of a Specific Exhibit
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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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:
Meteorites: Messengers of Mayhem
Treasure Hunt in Earth's Attic
Earth's Daughter
Impacts: Delivering Death and Fostering Life
Moon Views
Storm of Asteroids
Molten Moon
Protecting our Home
Protecting our Home (Spanish)
The Moon: Cosmic Decoder Ring
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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 limited funding to support shipping the exhibits. Please select which way you would like to cover the shipping:
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.
I would like LPI to cover the shipping costs.
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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?
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I have read and agree to the
Loan Guidelines
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