Online Form : : Southeastern Museums Conference

* = denotes required information

* Name of Museum or Business or Artist:

Address 1:
Address 2:
City/State/Zip:
Contact Person:
* Telephone:
FAX:
* E-mail:
* Item Title:
* Item Description (for catalog):
Valid dates or restrictions (if any):
Item's Estimated Retail Value:$
* Item will be:	Sent to the SEMC, 1788 Ponce de Leon Avenue, Atlanta, GA 31106 By October 13,2004
	Brought to the Conference no later than Wednesday morning, October 20, 2004
Comments: