LOAN REQUEST FORM Back to the Museum Home Page
Teaching Aid Boxes cannot be shipped. They must be picked-up and returned to
the Museum on the due dates. A Visa or Mastercard will be imprinted
at the time of pickup in the amount of $150.00 for each box. Upon the
safe return of the box the credit card charge will be voided.
Schol Name..................................................................................................................
Address..............................................................................................................
City: ................................. State:.................. Zip:..................................
School Phone:................................................................
Teacher’s Name:......................................................................................................
Signature:..................................................................................................................
Box Title:.........................................................................................................
Desired Use Dates...................................................................................
1st Choice:.......................................................................................................
2nd Choice:....................................................................................................
Print and return this form to:
Lizzadro Museum of Lapidary Art
220 Cottage Hill Ave.
Elmhurst, IL 60126
Reservation Dates of choice are given on a first come first serve basis. A
confirmation date of box reservation will be sent as soon as possible.
For Museum
Use Only
Box Title:
Date of Pickup:
Date of Return:
Teacher’s Signature:
Museum Authorization:
Date: