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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 *
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?

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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