ENTRY FORM

Your name:

First: Last:

Address:

Street:

City: State: Zip:

Phone:

E-mail:


Where did you learn about this opportunity?:

Status: (select one)

Number of Entries:

(If submitting more than 6, return to this page to complete the additional entries)

Entry fee total ($):

(mail fee and SASE to: Manifest Gallery, TRICK OF THE LIGHT, P.O. Box 6218, Cincinnati, Ohio 45206
or pay by credit card through paypal by using the link provided on the page that opens after submitting this form.)

I will be submitting my entries by:


attachment (send to show@manifestgallery.org)

ENTRY 1 ($10 fee)

Title:

Medium:

Size (h x w x d):

Date:

Sale Price (or NFS):
Insurance Value:

Notes:

ENTRY 2 ($10 fee)

Title:

Medium:

Size (h x w x d):

Date:

Sale Price (or NFS):

Insurance Value:


Notes:

ENTRY 3 ($10 fee)

Title:
Medium:

Size in Inches (h x w x d):

Date:

Sale Price (or NFS):

Insurance Value:

Notes:

ENTRY 4 ($10 fee)

Title:

Medium:

Size (h x w x d):

Date:

Sale Price (or NFS):

Insurance Value:


Notes:

ENTRY 5 ($10 fee)

Title:

Medium:

Size (h x w x d):

Date:

Sale Price (or NFS):

Insurance Value:


Notes:

ENTRY 6 ($10 fee)

Title:

Medium:

Size (h x w x d):

Date:

Sale Price (or NFS):

Insurance Value:


Notes:

 

Double check the information you entered above. Clicking SUBMIT indicates that you agree with the conditions of entry and exhibit as outlined in the prospectus.

(A copy of your entry will be automatically sent to the e-mail address you provided.
Please print and retain the e-mail for future reference. If you do not receive this email right away, please check your spam box.)