uzoMa  ENTRY FORM

Please type or print.

Name:                                                              Show:

Phone:

E-mail (optional unless e-mailing submission):

Website(optional):

Address:

City/State/Zip:

Country:

Submission Title:

Medium/Genre:

Approximate Dimensions - Artwork/ Approximate Length - music, film or performance:

Is submission for sale?

Pricing, if for sale:                               

(Please include gallery commission of 30%)

Please note here if you do not want your artwork available for print/duplication/promotion:

Artist’s Statement:

Hold Harmless Agreement:

I agree to hold uzoMa, & its’ staff and volunteers harmless for any damage, theft or loss of artwork of any kind. I understand the risk of submitting/sending artwork, and accept it.

I verify that I have read and agree to the submission guidelines as detailed by uzoMa.

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Artist’s Name – printed                                       Artist’s Name – signed, dated

1813 frankfort avenue • louisville ky 40206 • 502.895.9805 • uzoma@sprynet.com