ENTRY REGISTRATION FORM (PLEASE PRINT LEGIBLY)

1. ARTIST:____________________________________________________

STREET ADDRESS_________________________________________________

CITY___________________________ STATE___________ZIP_____________

PHONE HOME_________________ WORK__________________________

MEDIA__________________________________________________________

TITLE__________________________________________________________

Purchase Price __________________Not For Sale__________________

2. ARTIST_____________________________________________________

STREET ADDRESS_________________________________________________

CITY__________________________ STATE____________ ZIP______________

PHONE HOME____________________WORK__________________________

MEDIA__________________________________________________________

TITLE_________________________________________________________

Purchase Price ___________________Not For Sale_________________

Return this application with your fee of $10 per entry to Elsie Monthei, or bring it with your art work to convention.