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Request for Reconsideration of Audiovisual Materials <br /> Title <br /> Format <br /> Author <br /> Producing Company (if known) <br /> Year produced/Copyright date <br /> Request initiated by <br /> Address <br /> City State Zip <br /> Telephone (Home) (Work) <br /> Library Card # <br /> Do you represent . Yourself An organization Other group (name) <br /> 1 . To what in the work do you object? Please be specific . <br /> 2 . Did you view/listen to the entire material If not, what parts? <br /> 3 . What do you feel might be the result of exposure to this material? <br /> 4 . For what age group would you recommend this material? <br /> 5 . What do you believe is the theme of this material? <br /> 6 . Are you aware of judgments of this material by professional critics? <br /> 7 . What would you like your library to do about this material? <br /> 8 . In its place, what material would you recommend? <br /> Signature Date <br /> PLEASE NOTE : This is a public document under Public Law . Your name and address are subject to <br /> disclosure upon public request. <br /> Page 13 <br />