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Apply for Active Earth Display


* denotes required fields.

1. Basic Info
First Name *
Last Name *
Email Address *
Customization setting   *
2. Additional Info
Institution *
Department
Address *
Address 2
City *
State / Province *
Zip/Postal Code
req for US (5 digits) and Canada (6 chars) only.
*
Country *
Phone *
Alternate contact at your institution
Alternate contact's phone
Alternate contact's email
3. Display Info
Display name (or title)
Up to 80 characters; for ID purposes only, not visible to users
*
Display content   *
Enter a short code for your display
4-10 characters in length, in CAPS, digits OK. example: HAWAII3
*
Venue type *
Approx no. of visitors per month
per month
*
4. Hardware Info (optional)

We are curious about the computer you intend to run the display on.

Computer model
Operating system
Monitor brand
Monitor type
Is the monitor a touch screen?

space
Data Management Center
1408 NE 45th St. Suite 201
Seattle, WA 98105
Phone: 206.547.0393 | Fax: 206.547.1093
PASSCAL Instrument Center
100 East Road • Tech Industrial Park
New Mexico Tech • Socorro, NM 87801
Phone: 505.835.5070 | Fax: 505.835.5079

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