| Today's date: |
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| Select a suitcase to check out: |
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| Date case will be picked up: |
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| Estimated time suitcase will be picked up: |
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(Cases may be picked up on Tuesday from 11 am to 5 pm and Wednesday-Thursday from 9 am to 5 pm) (A valid ASU ID or driver's license is required for pick up) |
| Date case will be returned: |
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(Suitcases must be returned within 2 weeks of the pickup date) |
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| Name of person requesting the suitcase: |
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| Address: |
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| Phone |
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| Cell Phone |
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| Email address: |
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| Affiliated School: |
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| Grade Taught |
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| How many people will be viewing the suitcase? |
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| Where did the requestor hear about the Museum suitcases? |
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| Borrower's Signature |
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| Date |
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Submission of this form is acknowledgement that you accept full responsibility for the repair or replacement of the suitcase and its contents should it be lost, damaged, stolen, or destroyed. You are also agreeing to return the suitcase on or before the documented return date listed above. Please contact Jill Kary at 870-972-2074 if you have questions.
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