Display Application

Loan of the Huntington's Disease Memorial Quilt (hereafter called the Quilt) will be made on a first come first choice basis. Please include this application, describing your event and display site, as well as your goals in displaying the Quilt. Include as much detail as possible in order to provide the Hunt-Dis HD Quilt Project with the most complete information. E-Mail the application to jemiller@tampabay.rr.com or mail it to:

Hunt-Dis HD Memorial Quilt Project c/o
Jean E. Miller
1835 Pine Cone Circle
Clearwater, FL 33760-5349

Requestor:
Organization:
* Responsible Party Name:
Title/Position
Mailing Address
Phone:
Fax:
Email:
Display Dates:
Name of Event:
Estimated Attendance:
Open To Public:	___Yes ___No

* It will be the Responsible Party's duty to insure the Quilt is properly taken care of and protected during the loan period.

Display Site and Shipping Information

The Quilt should be shipped to the venue in which it will be displayed. The Quilt will be shipped to you C.O.D. insured. Your organization is responsible for returning the Quilt and is required to pay shipment and insurance costs. Phase I of the Quilt weighs approximately 15 pounds. One section is 10' by 10' and is suitable for hanging. The other section is smaller and can be displayed on a tabletop. At no time should the quilt be laid on the floor. All displays must be indoors and the area regularly monitored. The Quilt is to be locked up or otherwise protected when display hosts or building security is not available. The Quilt will be accompanied by a Bio Book and the Phase II Quilt Scrapbook. These bios are not replaceable and the loanee is requested to take every measure to protect them along with the Quilt.

Display site:
Shipping Site (if different)
Contact Person:
Phone Number:
Email:

Media and Maintenance Donations

A suggested Media Package and a Maintenance Donation sheet will be provided to you upon acceptance of your application. All donations received for the Maintenance of the Quilt while it is displayed at your event are to be sent to the "Hunt-Dis HD Memorial Quilt Project" to the attention of Jean Miller.

Signature:
Date

- published June 17, 2001