Date MM DD YYYY Name * First Name Last Name Email * Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Website or Social Media http:// Website or Social Media http:// Website of Social Media http:// What is your medium? * Brief artist statement. Please include a description of your inspiration, process, and retail price range. * Thank you! Someone from our Jury Committee will be in touch with you soon!
