Apply for the Display Cases or Art Gallery

2. Name*
3. Organization Name*

   If none, enter "N/A"

5. Address*
7. City*
8. State*
9. Zip Code*
11. Email Address*
12. Phone Number*
14. If the applicant is an organization, please provide a description of the organization including any local, national, or international affiliation, a brief history of the organization, the organization’s website address (if any), its nonprofit status, and any other relevant information.*

    If none, enter "N/A"

16. Please provide the dimensions and weight of the item(s) to be displayed.*
17. Please list the dates or date range during which you would like your content to be displayed.*
19. Please indicate where you would like your content to be displayed:*

    1. Front Display Cases
    2. Rear Art Gallery
23. Please attach color photograph(s) of all sides of the content to be displayed. If the amount of files exceeds those available below, please email photos to Cara Enos, Assistant Director, at cenos@burlington.org
25. Attach image below*
26. Attach image below
28. Attach image below
29. Attach image below
31. Attach image below
32. Attach image below
34. Attach image below
35. Attach image below
39. Review and agree to the conditions below:*

    1. By submitting this application, I hereby acknowledge that I am in receipt of and that I have read and understand the Burlington Public Library's Display Case, Art Gallery, and Bulletin Board Policy and agree to abide by all the requirements set forth therein.
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field