"The World Around Us"
Please type or print clearly
Name_____________________________ _________________
Address____________________________________________
City__________________________ State ____ Zip Code_________
Phone (H)__________________ (W)_____________________
E-mail Address_________________________________________
Medium (check one) Color Print _____ Black & White Print_____
Digital image____
Title of Image____________________________________________
If untitled, please print �untitled� in the blank.
Category (check one) Portrait ___ Still Life___
Landmark or Structure___ Landscape or natural feature___ Other___
I certify that I am an amateur photographer and that I am the one who took this photograph. I certify that this photograph has not been previously published elsewhere and that I hold the artistic copyright on this image.
Signature_______________________ Date____________
Flyer at Rec Center_____ Newspaper (Please specify) ___________________________
San Mateo County Chamber of Commerce ART Share FCTV____
Faire_______ Newsletter_____ Website_____
Foster City
Event (Please specify) __________________ Other (Please specify)_____________________
Resident___ Date Received _________ Entry number________
Non resident _____