Artist Name:
Address:
City, State, Zip:
Phone Number(s) day: eve:
Email Address:
Number of pieces, brief description, whether two or three dimensional, their sizes, and your medium:
May we have permission to use your name in media coverage, advertising, general publicity or on the Kissing Girls website? Yes No
May we have permission to use a photograph of you or your art in media coverage, advertising, general publicity or on the Kissing Girls website? Yes No
May we have permission to video tape your art for archival
purposes only (not for sale or reproduction)? Yes No
Demographic Information (Optional)
Do you define yourself as a Lesbian? Yes No
Age Race/Ethnicity
Differently Abled Yes No
Please describe (include information about any assistance you might need in order to help make your Lesbian Art Show participation easier).
Are you a past participant in the Lesbian Art Show? If so, When? Yes No
Thank you for applying. This application is DUE BY October 19.