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ENTRY FORM Name 
Address 
Telephone 
Day 
Evening 

I have read and accept the terms of the AGREEMENT  printed on the reverse of this form, and affirm that I meet the eligibility requirements stated in the PRINTS: WASHINGTON exhibition announcement.

If I am unable to pick up my print on the date specified in the schedule of the exhibition announcement, I designate ... to do so for me.

Description of print entered:
Title 2/25 Lunch time

Medium (Be specific about techniques used.)
woodcut, handprinted on Hosho rice paper, edition of 25

Dimensions of plate or image, in inches, height and width 22X12
Date created 
Value for insurance purposes $150
Signature 
Date 

RECEIPT FORM (Send with entry form.)

The following print has been received for jurying for the PRINTS: WASHINGTON exhibition:

Artist's name 
Title of print
Medium 
Dimensions
Recipient's signature 

LABEL (Do not send with entry form.)

Artist's name 
Title of print
Dimensions of plate or image, in inches, height and width 
Medium 
Date created 
Artist's telephone 
Day 
Evening