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2ND WORLD BLACK AND AFRICAN FESTIVAL OF ARTS AND CULTURE

ZONE   USA/CANADA ZONE
COUNTRY  USA

Entry Form For All Visual Art Exhibitors

1. LAST NAME  Smith   FIRST NAME   Vincent
MIDDLE  Da Costa   OTHER NAMES
a. ADDRESS city 264 East Broadway state NYS zip 10002
b. TELEPHONE CONTACT 1. 9am-9pm Number 625-2603
                     2. All other times Number 674-5324

2. Details of Birth, Education, Training, Associations to which you belong, etc.  
Separate sheet.