Gifting Items Proposal Form

Name *

Postal Address

Email *

Phone number

Give a brief description of the item/s: *

Images of item/s

Where did you get the item/s from?

Are you the current owner of the item/s?

Yes No

If NO, please state the name of the owner:

If NO, how are you connected to the owner?

If No, do they agree to donate the item/s to the Hokitika Museum?

Yes No

Is there a copyright on the item/s?

Yes No

If YES, please state name of Copyright holder:

Who made the item/s?

What is the date of manufacture?

Is there any damage to the item/s?

How are the item/s related to the West Coast region?

Is there a STORY connected with the item/s?

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