Checkout Request Form
The following video check-out request is made in accordance with the terms and conditions of membership in the Beacon Institute. Only one video may be on-loan to a member at a time. You must have returned any previously loaned video in order to make this request.
Reminder to Beacon Institute VideoEducator Users: This is a 60 day video check out. At the end of 60 days your video must be returned to the Beacon Institute. Failure to return videos on time can result in fines or suspension of your membership.
To checkout a video from the loan library, please fill in all the fields below marked with an asterisk (*).
* First Name
* Last Name
* Name of Agency
* Attention
* Address 1
Address 2
* City
* State
* Zip
* Contact phone number
Fax Number
Video Requested
First choice
* Product #
* Title
Second choice
* Product #
* Title
*The second choice will be shipped only if the first choice is temporarily unavailable.
Beacon Health - 75 Sylvan Street, Suite A-101 Danvers, MA 01923 USA
Questions/Comments: Contact Us: Tel: 800-553-2041 Fax: 800-639-8511
Please include Agency Name, Address, Phone & Fax
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