International Quilt Request Form

To request sections of The AIDS Memorial Quilt created and housed in the United States, please contact the NAMES Project Foundation in Atlanta, Georgia


Sponsor and Display Information

Our organization can provide portions of the International Quilt to US-based schools, churches and organizations. These sections of Quilt were created in Africa, Asia, South America, and multiple European countries, and are owned by their respective countries. If you are interested in requesting international sections, please fill out the form below. This is not affiliated with The NAMES Project Foundation. This form needs to be received by our offices at least 4 to 6 weeks before your event.

Contact Name:

Title:

Address:

City/State/Zip:

Contact Phone:
(Please include area code)

Work:

Fax:

Home:

Email Address:


Sponsoring Organization:

Type of Organization:
 ASO/CBO
Business
Church
Primary school
Middle school
High school
Medical/Hospital
Prison
Other

Address:


City/State/Zip:


Type of event:
(AIDS Awareness/Health Fair, Memorial service, Conference, World AIDS Day, other)

Event Phone:

Event Address:
(if different)

Street and City

Nearest Cross Street:

If multiple locations, please list:

Location of event:
(School, hotel, convention center, hospital, church, other)

Transportation Directions:
(Subway line or bus stops)


Racks: (rental fee $35/rack - only available in NYC area)
Yes
No		 Open to Public:
 Yes
No
How will you display the Quilt:
Floor
Hang on walls
 


Quilt Information

We request an honorarium of $200-$500 per section for using the Int'l Quilt (to cover transportation and handling expenses). Schools (K-12) and churches who do not have the funds can inquire about our grants available to cover some or all of the honorarium. We request for you to arrange to pickup and return the Quilt within 24 hours of your display.

Request Event Date(s):
(Specify month & day(s) for display)

Display Time:
(Hours display will be open)

Pick-up
Date:
 Time:
By Who (& telephone number):


 Return
Date:
 Time:
By Who (& telephone number):


 

FORM OF SHIPPING:
Participants are required to pay for shipping (FedEx/UPS, messenger, etc) to your city and its return. Please allow ample time for delivery—up to 7 business days if using ground services.  Only trackable forms of shipping are acceptable.

FedEx/UPS Account #
Hand delivery
Other If so, explain: 

PANEL REQUEST (by country):
Please select which country and amount (maximum available is two for most countries).  As participating countries change throughout the year, no application can be confirmed until this form is completed and received.

Europe:
Belgium (12ft x 12ft)
France (12ft x 12ft)
Netherlands (12ft x 12ft)
Russia (12ft x 12ft)
Spain (12ft x 12ft)

Africa:
South Africa (12ft x 6ft)
Zimbabwe (12ft x 12ft)

Asia/South Pacific:
Australia (12ft x 12ft)
Philippines (12ft x 12ft)
Thailand (12ft x 12ft)

North America:
Canada (12ft x 12ft)

South America:
Argentina (12ft x 6ft)
Venezuela (12ft by 6ft)

AMOUNT OF QUILT SECTIONS (check what applies):
2 to 5 sections @$200/each section
5 (+ 3 bonus) = $1,000
more than 8

Total Honorarium
$
(form cannot be processed without amount)

No. of Visitors Expected:
(Please estimate)

Type of Audience:
(General public, government, students, congregation, etc.)

How referred:
(Individual or organization)

Other requests:

For Displays Outside USA

These displays require a four (4) to six (6) month planning state and commitment. Minimum funds must be raised to cover the costs for an IAPI or Global Quilt ambassador to accompany the Quilt to your country; and the expenses for your display venue, display, and staff costs for your event. Each participant needs to be able to answer yes to the three questions below:

Yes No We can raise the funds for airline ticket to transport the Quilt and it's ambassador to/from your country.
   
Yes No We can raise the funds for hotel/accommodations for Quilt ambassador during the dates of the display.
   
Yes No We can provide ample volunteers and/or staff to manage the setup, breakdown, promotion, and protection of the Quilt during our event.

If you are planning on more than one display while the Quilt is in your country/city, please list potential sites and your plans:

 

Security Information

Security Contact:
 Telephone:

Security Arrangements:
(Explain how the Quilt will be protected throughout the entire display or event)





Please remember to fill out the Outreach Profile Form as well!