Memory Boxes Material Online Request Form

Name:

Phone number:

Email:

Home address:

Date and time requested:

Time required:

(REMINDER: Appointments available Tuesdays, Wednesdays and Thursdays, between 9:00 AM and 4:30 PM, maximum 2 hours per appointment)

Purpose of research:

Material(s) requested:

#	Box No.	Item No.	Title
1.	Box number	Item number	Title
2.	Box number	Item number2	Title2
3.	Box number3	Item number3	Title3
4.	Box number4	Item number4	Title4
5.	Box number5	Item number5	Title5

I, ,

acknowledge that I have read and understand The Township of Tiny Heritage Advisory Committee’s Archive Collection Use and Reproduction Policy and agree to follow the guidelines set therein.

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