Media Request Form
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Name
*
First Name
Last Name
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Email
*
example@example.com
Location
*
City, Province, Country
I have the materials in my possession:
*
Yes
No
I am interested in loaning or donating the artifact(s):
*
Loaning
Donating
Not sure
Please select the type of materials:
*
Photographs
Documents
Books
Objects
Artwork
Other
If known, please select the time period that the artifact(s) are from:
Prewar to 1933
1933 to 1945
1945 to Present day
Other
Please detail where the items are from / were created in:
City, Town, Country
Please provide a brief description of the artifact(s):
Please provide a brief biography of the original owner, survivor and/or survivor family:
Recorded testimony and/or memoir:
Please provide the names of anyone with a connection to the object who recorded testimony and/or the name of any published written material, for example an Azrieli Memoir.
Please provide approximate measurements of the object(s):
Upload photograph:
Browse Files
Drag and drop files here
Choose a file
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Please add any additional comments or information:
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Submit
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