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Artist's Name____________________________________________________________
| Check one: |
employee |
volunteer |
medical staff |
community member |
Phone (work and home): ____________________________________________
Email address (work and home): ______________________________________
I prefer to show my artwork at ____Sacred Heart
____PHMG Downtown ____either place
Image list (to
submit more than 4 pieces, duplicate this form)
1. Title ________________________________
Size (HxW)______________
Media (watercolor, oil painting, etc.)
_______________________________
Retail value ______________2. Title ________________________________ Size
(HxW)______________
Media _______________________________________________________
Retail value
______________
3. Title ________________________________ Size (HxW)______________
Media _______________________________________________________
Retail value
______________
4. Title ________________________________ Size (HxW)______________
Media _______________________________________________________
Retail value
______________
I understand the Requirements of the Artist and I agree to abide by those requirements if my work is
selected for display.
Signature
Application Deadline
All application materials must be delivered to PeaceHealth Public Affairs (SSB, 4th floor) by 5 p.m.
Friday, Oct. 5, 2007. For information contact Bonnie Henderson, Public Affairs, 686-7135,
bhenderson@peacehealth.org.
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