Picture Placitas Entry Form

 

 

Name: __________________________

Address: ________________________
 
Phone__________________
 
Email:_________________
 

 

Titles

 

1_________________________________

 

2.________________________________

 

3.________________________________

 

Entrant's background (in 50 words or less, use other sheet if necessary.)

 

 

 

 

 

WAIVER OF LIABILITY: In submitting my work for PICTURE PLACITAS, I warrant that this is my original work and that there is no copyright infringement. If the art work contains easily recognizable people,all necessary releases have been included with this submission. I understand that the art work will not be returned to me, but will become the property of the Placitas Library.

 

Signature:

 

__________________________________