Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

(for mailing payment for sold work)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Checkbox *

I have read the guidelines. If the Committee disqualifies my artwork, I will accept its return without question. All reasonable care will be taken to ensure the safety of the exhibit. I, the undersigned, do hereby certify this is my original artwork and release the LVAA from all responsibility due to loss or damage and all Copyright infringements. I will complete my payment for up to 3 artworks, or $30 total.

Yes