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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.