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   Entry Form


Please print or type

Artists Name____________________________________________________

Mailing Address: 

City ________________________________________________________________________________________________________________

State__________________________________________________                 Zip_______________________________________

Phone__________________________________________________________

E-mail__________________________________________________________



1. 


Title____________________________________________________________________________________________________________________

Medium____________________________________________________________________________________________________________

 Size (hxwxd)_____________________________________________________________________________________________________

  
Sale $_________________________Ins. Value (NFS) $____________________



2. 

 Title_________________________________________________

 Medium____________________________________________________________

 Size (hxwxd)________________________________________________________
_
  Sale $____________________________Ins. Value (NFS) $__________________


Mail to:


Jim Sullivan
1921 Joy Ridge Rd.
Occidental, CA 95465 E-mail