* indicates required field

*First Name: *Last Name:
*Email:
*Telephone number:

Shipping Address for return:
*Address 1
Address 2
*City
*State
*ZIP/Postal Code
Countryoptional except those outside of US

Return Shipment Costs

*I will send pre-paid UPS or USPS label or postage: yesno
OR *I will pay the gallery for UPS or USPS shipping costs: yesno

Return Shipment Notes:
1) Insurance over the carrier standard insurance will be added at your instructions only.
2) International participants: shipping arrangement will be made via email with the gallery separately.

Please provide additional information about the image that has been accepted for the show:
Image Information
*Image Title:
*Portfolio Title (if part of a series or enter "none"):
*Print Dimensions (height and width inches):
Framed Dimensions (height and width inches) (if applicable):
*Size of edition (or "none"):
*Process (e.g., inkjet, pigment, silver gelatin, digital c-print, etc.):
*Price of print only:
Framed Price (if applicable):
*Other sizes available? (provide dimensions, edition, process, and price for each, if any. Enter "none" for for none):

Artist Statement(written in first person) (not more than 150 words):

Artist Bio(Written in 3rd person) (not more than 150 words):