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Herbarium Specimen Off-Campus Loan Request Form

Please complete the form below and click SUBMIT when finished.

(MM/DD/YY)

Type of Specimen:

Borrower's Full Name:

Title/Position:

Institution Name:     Institution Acronym:

Address 1:

Address 2:

Address 3:

City, ST, Zip: ,

Country:

Email:

Phone:

Researcher's Full Name:

Researcher's Title/Position:

Descriptions of Specimens and Remarks:

Please provide as much detail as possible. (i.e. specimen numbers, locations, geographic scope, synonyms, expected term of loan, etc.)


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