[Prospectus Page] [ID Tags]

Great Lengths Entry Form

Entry Form: Fill out the form online and print it, or save it to your hard drive to fill out later. (Under "File," click on "Save As..." and save as a Web page. To open the form, double-click on the form icon. Then fill it out and print it. When printing the form, set left and right page margins to 0.25.)
Last name First name HGA member number
Street address
City State/Province Zip/postal code Country
Day phone Evening phone
Email address
Fax Number
In collaboration with

This agreement must be signed and returned with the entry form.

I understand that submission of artwork constitutes my permission for HGA/Convergence 2006 Grand Rapids to photograph the work and/or duplicate or reproduce slides for publicity and promotional purposes. I am in agreement with all conditions set forth in this prospectus and entry form.

____________________________________________________________________________________________________
      Signature
Date

____________________________________________________________________________________________________
     Signature of Collaborator
Date

Credit card number:

    Visa Mastercard American Express Discover
Expiration date
Name on card


___________________________________________________________________________________________________
      Signature of Cardholder
Date

The above credit card information is required to process this entry form and will be used to guarantee return shipping if return postage is not included.
Entry Fee payable in US funds (check one)
$20 HGA member
$35 Non HGA member
Student (attach a copy of Student ID from accredited educational institution) no fee
Payment Method (check one) Check or money order enclosed in US funds      Charge to credit card above
When printing the entry form, the printed text is limited to what is visible on your monitor’s screen.

Entry One: (Only one piece may be “Untitled” )
Title
Insurance/Cost Value:
(For values over $2,000 please contact HGA (678.730.0010) before submitting entry)
Height Width
Weight
Description/Technique

Materials used

Entry Two: (Only one piece may be “Untitled” )
Title
Insurance/Cost Value:
(For values over $2,000 please contact HGA (678.730.0010) before submitting entry)
Height Width
Weight
Description/Technique

Materials used
Photographer Credit
 Photographer Credit
Please photocopy this form for your records

 

Return:

  • completed entry form with signed artist’s agreement
  • two slides per piece entered with dots indicating the top right-hand corner
  • entry fee—check, money order in US Funds, or valid credit card information

To:

Great Lengths
Handweavers Guild of America, Inc.
1255 Buford Highway, Suite 211
Suwanee, Georgia 30024
USA
©2005 Handweavers Guild of America, Inc.