Name: |
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Address: |
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City: |
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State, Zip: |
_________ , ______________________________________ |
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Phone: |
(_____) _____ - __________________________________ |
Email: |
__________________________________________________ |
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Email and Postal Address and Name of Local Newspaper:
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How did you hear about us? (If ad - list publication/website) |
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Entry 1: |
Title: |
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Medium: |
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Size: |
Height:_________ Width:__________ Depth:__________ |
Price: |
__________________________________________________ |
Name of Award: |
__________________________________________________ |
Name of Exhibition Giving the Award: |
__________________________________________________ |
Sponsor/Organization of Awarding Exhibition: |
__________________________________________________ |
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Entry 2: |
Title: |
__________________________________________________ |
Medium: |
__________________________________________________ |
Size: |
Height:_________ Width:__________ Depth:__________ |
Price: |
__________________________________________________ |
Name of Award: |
__________________________________________________ |
Name of Exhibition Giving the Award: |
__________________________________________________ |
Sponsor/Organization of Awarding Exhibition: |
__________________________________________________ |
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Entry 3: |
Title: |
__________________________________________________ |
Medium: |
__________________________________________________ |
Size: |
Height:_________ Width:__________ Depth:__________ |
Price: |
__________________________________________________ |
Name of Award: |
__________________________________________________ |
Name of Exhibition Giving the Award: |
__________________________________________________ |
Sponsor/Organization of Awarding Exhibition: |
__________________________________________________ |
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Entry 4: |
Title: |
__________________________________________________ |
Medium: |
__________________________________________________ |
Size: |
Height:_________ Width:__________ Depth:__________ |
Price: |
__________________________________________________ |
Name of Award: |
__________________________________________________ |
Name of Exhibition Giving the Award: |
__________________________________________________ |
Sponsor/Organization of Awarding Exhibition: |
__________________________________________________ |
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Entry 5: |
Title: |
__________________________________________________ |
Medium: |
__________________________________________________ |
Size: |
Height:_________ Width:__________ Depth:__________ |
Price: |
__________________________________________________ |
Name of Award: |
__________________________________________________ |
Name of Exhibition Giving the Award: |
__________________________________________________ |
Sponsor/Organization of Awarding Exhibition: |
__________________________________________________ |
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