Art Contest Submission Form

Member Name: (First and Last) *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Organization *

Short Description of Artwork *

Artwork Title *

Upload Artwork Here: *

Artist Name: *

Relationship to Member: *

Do you confirm that this artwork is your original creation and not a copy or reproduction of someone else's work? *

Yes

No

Do you grant permission for your artwork to be publicly displayed and used in any promotional materials? *

Yes

No