First Name
Last Name
Email Address
Confirm Email Address
Telephone Number
Your Zip/Postal Code
Name of Museum
Location (City/State)
Date of Visit
Name of Exhibit (if applicable)
Name of Guide/Staff Member (if applicable)
Type of Bias (Check all that apply
Detailed Description of the Concern:
Supporting Evidence (Optional)
How do you believe the museum could improve or address this concern?