ENTRY FORM - 2021 MPSGS Exhibit

Failure to complete this form may result in your non-participation in the exhibit.

    
  First Name
 
MI
 
Last Name
 
Name Suffix
Jr., II, etc.
 
Address Address 2 City State/Province

     
Country Postal Code Telephone Number E-mail Address

     
ARTWORK MAILED/DELIVERED TO: (Your Receiver) Check if you are a NEW artist to exhibit

   
Artwork Title
*Medium or
Material for Sculpture
Check if
Sculpture

Price
1             $          
2             $          
3                   $          
     Outside Dimensions: Fill in entry data (above) then type in whole inches & select fractions from drop down  
1
2
3

*List Medium of your work, not the award category. If the work is on ivorine, note that in the Medium column.

         Entry Fee   $            Please select method of payment:     Please select a payment method from the drop-down list.         
Additional Insurance (Optional) $   Note: The value you entered has been rounded down to the nearest whole dollar    
2022 Membership Dues (elected members only) $ All artists can pay via PayPal (tap3738@aol.com). If paid via PayPal
Donation (Optional) $   Note: The value you entered has been rounded down to the nearest whole dollar     by someone other than the artist, type their name
Total Amount Paid $ here:     and please make a note in PayPal.   Please type the actual PayPal payer's name.         
 
  If you want to receive payments by PayPal   If paid by check, make check payable to "MPSGS", and mail to:
for awards and/or sales, please check here:   Tom Penn
  MPSGS Treasurer
BEFORE submitting the Entry Form,           3040 Hickory Ridge Rd.
PRINT this document for future reference.            Dunkirk, MD  20754-9670            Enter check number here:     Please enter your check number.         
 
By submitting this form, the artist agrees to all terms and    
conditions in the Prospectus.                                                     
 
                    

 

Tags (below) will print on a second page.


 
 
 
 
  Cut out tags and attach to backs of works.      Caution: Data cannot be entered into tags
  Data in Tags will be auto-filled.

 
 
  1.        New Artist    MPSGS use:

 
 
 
  Artist:  
  Address:
 
     
  Tel #:  
  Email:
  Med. or Sculpt. Mat.   Price $ 
  Title:  
  Artwork Receiver:
  2.        New Artist    MPSGS use:

 
 
 
  Artist:  
  Address:
 
     
  Tel #:  
  Email:
  Med. or Sculpt. Mat.   Price $ 
  Title:  
  Artwork Receiver:
  3.        New Artist    MPSGS use:

 
 
 
  Artist:  
  Address:
 
     
  Tel #:  
  Email:
  Med. or Sculpt. Mat.   Price $ 
  Title:  
  Artwork Receiver:
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