I have read and agree to abide by the rules enclosed with this entry form. Date (M/D/Y): ___/___/___
Artist or Authorized Signature (required) | __________________________________________ | ||
Artist name | ______________________________ | Agent name | ______________________________ |
& address | ______________________________ | & address | ______________________________ |
(required) | ______________________________ | (if any) | ______________________________ |
______________________________ | ______________________________ | ||
Telephone | ______________________________ | Telephone | ______________________________ |
Electronic mail | ______________________________ | Electronic mail | ______________________________ |
My art will arrive at the show:
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Return artwork to:
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Check here
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Check here
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Check here
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Check here
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$_____ Art Show Fee (total panels & tables) | Special Requests: ____________________________________________ |
$_____ Print Shop Fee ($1 per copy) | Make checks payable to: ______________________________________ |
$_____ Mail-in fee ($20 if permitted) | Put on wait list rather than reject request?
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$_____ Membership(s) (___@ $43) | Refund memberships if no space available?
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===== Please include the name(s) & address(es) for additional members on a separate sheet. This rate is good through January 16, 2006. | |
$_____ Total Amount | ![]() |
Charge my:
MasterCard or
VISA. Expiration date
(M/Y):___/___
Name on card: ______________________ Card #: ____________________________
Signature: _______________________________________