Panel Request Form

Thank you for your interest in seeing a panel from the AIDS Memorial Quilt at a display in Northern NJ. Please complete this request form and then submit it to us. You may also fax completed forms to us at 1-732-352-7920

Our chapter receives three shipments of Quilt form the National office each year. We are currently accepting requests for World AIDS Day 2008. The deadline for requests for Quilt panels to be included in World AIDS Day displays without incurring a rush charge* is August 1, 2008.
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*See Display Request Form for a detailed fee schedule including rush charges.

Please note that the National Office fills requests on a first come first served basis. Please contact us via email if you have any questions.

Fees

Gratis for Individual Panel Makers and Family members.

$50.00 per panel for requests by other individuals or by organizations.
Areas marked with a symbol must be filled in before submitting your request.
Today's Date
Block Number
If you do not know the block number please visit:
http://www.aidsquilt.org/searchquilt.htm
Name as it appears on the Panel
Your First Name
Your Last Name
Your Street Address
Your City
Your State
Zip
Your County
Phone - please indicate day or evening
Your Email Address
Is there an upcoming local display you want this panel included in?
If so, when are the dates of the display?