Contact Information Contact Name * Organization * Permanent Address * Local Address * Email Address * Phone Number Position * Faculty Student Tribal/Community Representative Other Other Institutional or Community Affiliation Visit and Research Information Purpose of Proposed Visit * Date of Proposed Visit (Start) * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year201720182019 Date of Proposed Visit (End) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year201720182019 Specific collection or objects requested for examination * Please list catalog numbers if available. Add as an attachment below if list is long. Specific archives or collections records requested for examination Geographic area(s) from where collections and/or archives originated: * North America Central America South America Europe Asia Africa Pacific Islands Middle East Australia/New Zealand Permissions I hereby grant permission to The Field Museum to release my name, address, and research questions to others with similar research interests: * Yes No I have read, understand, and agree to the terms of the Policies and Procedures for visiting collections (see http://collections-anthropology.fieldmuseum.org/media/92), including the access to collections and documents policy, the hazardous materials statement, the object handling and transport procedures, and photo archives protocols (please initial): * http://collections-anthropology.fieldmuseum.org/sites/collections-anthropology.fieldmuseum.org/files/Visit%20Policies%20and%20Procedures.pdf I agree to obtain written permission from The Field Museum’s Anthropology Head Registrar before I duplicate, publish, or present any photos or reproductions of the objects I have examined (please initial):: * I agree to provide The Field Museum with a copy of all publications resulting from the use of its collections (please initial): * I agree to provide The Field Museum with a digital copy of all images of its collections or resulting from the use of its collections, which the Museum may use for internal and exhibition purposes, include in and distribute through its database, and allow others to use for non-commercial purposes (please initial): * I agree to allow The Field Museum to use my image, audio/visual recordings of me, and brief abstract of my research and biography for its non-profit purposes, including database use and for promoting use of the Museum’s collections, including fundraising, in its publications, social media, etc. (please initial): Abstract Abstract/Project Description In the space below or as an attached document, please provide an abstract of your specific interests in our collection. If the visit is for research, please include a detailed research design. Attach abstract Files must be less than 4 MB.Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx zip.