Artist App. Form

2 Shot Goose Artist Challenge Form

Artist Information

Name _____________________________________________________________________________________________

Mailing Address _____________________________________________________________________________________

City, State, Zip ______________________________________________________________________________________

Home Phone ________________________________________________________________________________________

Work Phone ________________________________________________________________________________________

Fax _______________________________________________________________________________________________

Gallery Information ___________________________________________________________________________________

Are you interested in giving an art workshop? _____________________________________________________________

Are you interested in the Quick Draw Competition? _________________________________________________________

Please write a brief autobiography and description of your work:

___________________________________________________________________________________________________

Signature ___________________________________________________________________________________________

Date _______________________________________________________________________________________________

For Office Use Only:

Date Received: ____________________________________	Notification of Receipt Mailed: ________________________
Art Committee Decision: ____________________________	Notification of Decision Mailed: _______________________