United States Holocaust Memorial Museum
Outgoing Loan Application

Fields marked with an asterisk (*) are required.

*Institution:

*Address:

*City:

*State:

*Postal/Zip code:

*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.