Juried Exhibition Entry Form

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* 1. Artist Full Name

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* 2. Entry 1

Title

Medium

Dimensions

Price

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* 3. Entry 2

Title

Medium

Dimensions

Price

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* 4. Entry 3

Title

Medium

Dimensions

Price

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* 5. Mailing Address

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* 6. Phone Number

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* 7. Email

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* 8. Entry Checklist

I have paid the entry fee of $35 (must be received by January 17, 2018)

I have mailed or emailed up to 3 JPEG images of my artwork (must be received by January 17, 2018)