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Your name: First: Last: Address:
Street: City: State/Province: Zip/Postal Code: Country:
Street:
City: State/Province: Zip/Postal Code: Country:
Phone: E-mail:
Where did you learn about this opportunity?:
Status: (select one) Junior Senior 2007 Graduate
School:
Academic Reference (professor or advisor's name and contact): This person will receive a copy of your entry form by email.
First: Last:
Number of Entries: (If submitting more than 6, return to this page to complete the additional entries)
Entry fee total ($30): (mail fee to: Manifest Gallery, RITES OF PASSAGE 2008, 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 entry slides/images by:
Mail (CD or Slides) E-mail attachment (send to show@manifestgallery.org) ENTRY 1 Title: Medium: Size (h x w x d): Date: Sale Price (or NFS): Insurance Value: Notes: ENTRY 2 Title: Medium: Size (h x w x d): Date: Sale Price (or NFS): Insurance Value: Notes: ENTRY 3 Title: Medium: Size in Inches (h x w x d): Date: Sale Price (or NFS): Insurance Value: Notes: ENTRY 4 Title: Medium: Size (h x w x d): Date: Sale Price (or NFS): Insurance Value: Notes: ENTRY 5 Title: Medium: Size (h x w x d): Date: Sale Price (or NFS): Insurance Value: Notes: ENTRY 6 Title: Medium: Size (h x w x d): Date: Sale Price (or NFS): Insurance Value: Notes:
Mail (CD or Slides) E-mail attachment (send to show@manifestgallery.org)
ENTRY 1
Title: Medium: Size (h x w x d): Date: Sale Price (or NFS): Insurance Value: Notes:
ENTRY 2
ENTRY 3
Title: Medium: Size in Inches (h x w x d): Date: Sale Price (or NFS): Insurance Value: Notes:
ENTRY 4
ENTRY 5
ENTRY 6
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.)