GARIBALDI-MEUCCI MUSEUM
Garibaldi-Meucci Museum
420 Tompkins Avenue, Staten Island, NY 10305
Phone: 718-442-1608/Fax: 718-442-8635
DATE OF REQUEST: ______________________
PERSON REQUESTING RENTAL:_______________________________
ORGANIZATION:_____________________________________________
PHONE:_____________________________________________________
E-MAIL:_____________________________________________________
ADDRESS: _________________________________________________
_________________________________________________________
Donations gratefully accepted to cover cost of materials, postage and handling.
Please make checks payable to: GARIBALDI-MEUCCI MUSEUM
_____________________________________________________________
LIST OF REQUESTS (MAXIMUM OF 3):
TITLE:
___________________________________________________
___________________________________________________
___________________________________________________
LENGTH OF RENTAL:_________________________________________
(MAXIMUM OF 1 MONTH EACH)
FOR GMM USE ONLY
PAYMENT RECEIVED:___________________________________
NAME AT GMM FILLING REQUEST:_________________________
DATE REQUEST MAILED:_________________________________
DATE RETURNED:_______________________________________
PERSON REQUESTING RENTAL:_______________________________
ORGANIZATION:_____________________________________________
PHONE:_____________________________________________________
E-MAIL:_____________________________________________________
ADDRESS: _________________________________________________
_________________________________________________________
Donations gratefully accepted to cover cost of materials, postage and handling.
Please make checks payable to: GARIBALDI-MEUCCI MUSEUM
_____________________________________________________________
LIST OF REQUESTS (MAXIMUM OF 3):
TITLE:
___________________________________________________
___________________________________________________
___________________________________________________
LENGTH OF RENTAL:_________________________________________
(MAXIMUM OF 1 MONTH EACH)
Renter is responsible for return shipping costs.
PAYMENT RECEIVED:___________________________________
NAME AT GMM FILLING REQUEST:_________________________
DATE REQUEST MAILED:_________________________________
DATE RETURNED:_______________________________________