Application for Use of the Marion E. Wade Center
Reading Room
Research
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Dr.
Mr.
Mrs.
Ms.
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First Name
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Last Name
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Street Address
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Street Address, Line 2
City
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State/Province
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Zip/Postal Code
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Country (if non-US)
Phone Number
Email Address
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Purpose of Visit
Author(s) of Interest
Topic of Research
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Anticipated Dates at Wade
Professional Affiliations and Publication Information (if applicable)
Institution
Title or Position
Academic Level of Research
Highest Degree Completed
Director of Research
Other Publications
Expected Date of Publication
Proposed Title of Publication
Please note that we request a copy of your finished work to be sent to the Wade Center as part of the agreement for using our materials.
I request permission to use the Marion E. Wade Center for the project described above. I have read the regulations for the use of the Center, agree to abide by them and plan to deposit a copy of my finished work here.
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I agree that typing my name below constitutes my digital signature.
Signature
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Date
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