Application Date

Name
Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
Email

Work No. 1

Title of Work
Media
Weight
Dimensions
Price
Not for Sale
Wall Hanging
Free Standing
I will provide my own pedestal
I will pay $15 for pedestal usage

Work No. 2

Title of Work
Media
Weight
Dimensions
Price
Not for Sale
Wall Hanging
Free Standing
I will provide my own pedestal
I will pay $15 for pedestal usage

If there is interest in my art by prospective purchasers:

By typing your name in the signature block you attest that the above information is correct and you agree to all the rules of this show stated in the Call to Entry.

Signature