Institution__________________________________________________________

SEMC member number ______________________________________________

Address __________________________________________________________

__________________________________________________________________

City, State, Zip______________________________________________________

Contact Person ______________________________________________________

Telephone __________________________________________________________

Email ______________________________________________________________

Exhibition Opening ___________________________________________________

(Scheduled) Closing Date ______________________________________________

Budget Category:
___________Up to $25,000     ________Over $25,000
___________Over $100,000    ________ Over $1,000,000