Folklore Society of Greater Washington

Organization _______________________________________________________________

Address ____________________________________________________________________

City, State, Zip ___________________________________________________________

Phone (H) ______________________________ (O) _______________________________

Email ______________________________________________________________________

I, the above FSGW member, am borrowing the FSGW

____________________________________________________________________________

Equipment [for use by the above organization] on ______________________, ______.

I received this equipment complete and in good condition. I am personally responsible for its transportation, care and use.

I will return it complete, and in as good condition as when I received it, or I will repay FSGW for all repair or replacement costs.

I will give FSGW $_____________ towards the care and replacement of this equipment upon its return on _______________________, ________.

(Signature)________________________________