Name:  Organization: Position:

Address:   City:   State: Zip-Code:

E-mail: Telephone: Fax:

• 2009
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• 2012
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Desired Date:
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Are you a DALNET member library?
If so, would you like to book a free Gallery Talk by the WSU Art Collection Coordinator? Contact Sandra Schemske, 313-577-9264

Please explain your reasons for wanting to host the display (200 words max):

Will you plan additional programming in conjunction with the display? Describe briefly.

Please select which best describes you:
Public library
Academic library
Special library
Non-profit organization

What is the approximate size of the community you serve

Are you open to the public? Yes No

Approximate number of hours you are open to the public:

Approximate number of visitors you serve annually: