Senior Citizen Art Show Artwork Label "*" indicates required fields CompanyThis field is for validation purposes and should be left unchanged.First Name*Last Name*Street Address*Street Address 2City*State*AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code*Phone*Email* Age* 60s 70s 80s 90+ Category*Acrylic PaintingCraftDigital (Computer) ArtMixed MediaOil PaintingPastelsPrintPhotographySculptureWatercolor PaintingWorks on PaperIf mixed-media or 3-D art, specify materialsTitle*Year done*Artwork Height*Artwork Width*Artwork Depth*Artist Classification* Non-Professional Professional Price* Price on Request (POR) Not For Sale (NFS) Sale Price Sale PriceInsurance Value*(If POR or NFS you must enter the insurance value and name of company)Any entry with a dollar value exceeding $400.00 must be privately insured by the artist – either through their homeowners or rental insurance or through their art rider. Every attempt will be made to preserve, secure and protect entry, however, the sponsoring organizations will not assume responsibility for loss or damages incurred. Entry in the show signifies agreement and compliance with this waiverSignatureDate*
