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2. Thank you for your interest in the Riverview Hospital Artifact Collection.

   We are currently documenting offers to share information about artifacts in the collection, and requests to borrow objects from the collection for a display or exhibit for follow up in the future. Please complete and submit the form. Your information will be retained on file.

4. Name*
6. Mailing Address*
8. Email Address*
9. Phone Number*
13. Purpose of Inquiry*

    1. To declare my interest in borrowing artifacts from the Riverview Hospital Artifact Collection for a display, when this service is available. (Complete Section A)

    1. To share information or a story associated with an artifact in the Riverview Hospital Artifact Collection at a future date. (Complete Section B)
17. Name of Organization
19. Organization Website
21. Organization Mailing Address
23. Organization Email Address
25. Organization Phone Number
27. Please provide a summary of the content and purpose of the planned exhibition.
29. What is the location (address) where the exhibit or display will take place?
31. Is your organization a museum or other heritage organization?

    1. Yes
    2. No
32. Do you have professional curatorial and/or conservation staff to manage the loan?

    1. Yes
    2. No
34. Please list the artifacts from the Riverview Hospital Artifact Collection that you would be interested in borrowing for the exhibition. For each object, include its artifact number and artifact name.
38. Please provide a description of the artifact from the Riverview Hospital Artifact Collection that you would like to share information about. Please include its artifact number and artifact name as included in the Riverview Hospital Artifact Collection: Catalogue of Artifacts.
40. Thank you for completing this form.

    All forms submitted will be retained for follow up in the future. Please do not include any personal information other than your contact information.

42. Freedom of Information and Protection of Privacy Act

    I understand by submitting this form I am consenting to the collection, storage, use and disclosure of my personal information for the purposes of the Riverview Artifacts Collection Program in accordance with the Freedom of Information and Protection of Privacy Act. I understand that my personal information will be disclosed to a third-party service provider (i.e. website host Civic Plus) located in Canada for the purpose of processing your request. If you have questions or concerns about the collection of your personal information, please email Karen Basi, Cultural Services Manager .

    1. I understand
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44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field