| The Southern Vermont Arts Center's 52nd National Fall Open Exhibition Entry Form Please fill out this entire form, detach it, and return it with all works submitted. ------------------------------TYPE OR PRINT CLEARLY-------------------------- Name: ______________________________________________________________________________________ Address: __________________________________________________________________________________ City: ___________________________________________________ St: ___________________ Zip: ________ Email: ______________________________________________________________________________________ Telephone: _________________________________________________________________________________ I agree to the terms set forth in the exhibition prospectus. SIGNATURE_____________________________________DATE__________________________________ First Work Medium: ______________________________________________________________________________________ Price: ______________________________________________________________________________________ Second Work Medium: ______________________________________________________________________________________ Price: ______________________________________________________________________________________ Please return this form to the Southern Vermont Arts Center. PO Box 617, 930 SVAC Drive Manchester, VT 05254 802-362-1405 |