PASSIONATE PURSUITS

INTENTION TO EXHIBIT FORM
Keene State College alumni, faculty, staff, and Friends of the Thorne share their arts, crafts, and collectibles.

Exhibit dates:

• Opening: June 4, 2010 – KSC reunion weekend
• Closing: July 28, 2010
• Reopening September 3-30, 2010

Deadline:
Complete and submit this form or the optional PDF form by April 19, 2010.

Questions?
E-mail: thorne@keene.edu
Phone: Maureen Ahern, 603-358-2721, or Paul Knowlton, 603-358-2240

All fields marked with an * are required.
*	Please select your status Select from list KSC Faculty KSC Staff KSC Alumni Friends of the Thorne
*	First/Preferred Name
*	Last Name
	E-mail Address
*	Phone Number The best number for contacting you Example: 603-555-1212
*	Street Address
*	City
*	State/Province Select state/province New Hampshire Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Jersey New Hampshire New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Other - state not listed
*	ZIP/Postal Code
Exhibit Items/Collection Information
Item 1
*	Item 1 – Description of artwork or collection
*	Item 1 – Dimensions
Item 2
	Item 2 – Description of artwork or collection
	Item 2 – Dimensions
Item 3
	Item 3 – Description of artwork or collection
	Item 3 – Dimensions
After clicking Submit Form – a Confirmation page should open