Potential Donation Form Online Donation Form Form for donating to the Museum's Research Center and Object Collection. Name/Nombre* First Last Address/Direccion* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Primary Phone/Telefono Principal*Other Phone/Otro TelefonoEmail* What kind of item is it?/¿Qué tipo de artículo es?* Object/artifact Archaeological object Fine art (painting, sculpture, etc.) Textile Audio recording (album, DVD, oral history, etc.) Book Photograph Map Picture (postcard, poster, etc.) Architectural drawing or record Manuscript Scrapbook Other printed material (menu, ticket, ad, periodical, etc.) Other (describe below) Other1. Briefly describe the item or collection/Describa brevemente el artículo o la colección:*Include information such as quantity (number of boxes or items), size, manufacturer (artifacts only) and creator and/or collector. Include actual or estimated date or range of dates of creation. Incluya información como cantidad (número de cajas o artículos), tamaño, fabricante (artefactos solamente) y creador y / o coleccionista. Incluya la fecha actual o estimada o el rango de fechas de creación.2. Describe its physical condition/Describa su condición física:*3. What can you tell us about this item or collection?/¿Qué nos puede decir acerca de este artículo o colección?:*Please tell us what you know about the creator, owner, date(s), or interesting history, etc., of this item or collection. How does it or they relate to South Florida or the Caribbean?/Por favor díganos lo que sabe acerca del creador, propietario, fecha (s), o historia interesante, etc., de este artículo o colección. ¿Cómo se relacionan ellos con el sur de la Florida o el Caribe?4. If the item is an object/artifact can you provide a digital image (up to three images) or photograph of it or them?/Si el objeto es un objeto / artefacto, ¿puede proporcionar una imagen (hasta tres imágenes) digital o una fotografía de él o de ellos?YesNoAttach Image/Adjuntar ImagenFileDescriptionAttach Image/Adjuntar ImagenFileDescriptionAttach Image/Adjuntar ImagenFileDescription5. Please describe your relationship to the item. Do you own it? Did you create it or purchase it? How did you obtain it?/Por favor describa su relación con el artículo. ¿Lo tiene usted? ¿Lo creó o lo compró? ¿Cómo lo obtuviste?*6. Additional Comments/Comentarios adicionales: