1

Periodical Title:

Periodical Title:

2

Title of Article:

Title of Article:

3

Author(s):

Author(s):

4

Date of Article:

Date of Article:

5

Volume Number:

Volume Number:

6

Issue Number:

Issue Number:

7

Page Number(s):

Page Number(s):

8

Your Name-- first and last name required

Your Name-- first and last name required

9

Your MSLN Library Card Number -- the barcode number on the back of your library card -- for example, 2330200XXXXXXX

Your MSLN Library Card Number -- the barcode number on the back of your library card -- for example, 2330200XXXXXXX

10

Your Phone Number

Your Phone Number

11

Your Email Address

Your Email Address

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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