A Show of Hearts to Benefit “Art beCAUSE”

Registration and Release Form

Name:____________________________________ Phone:________________________

Address: ________________________________________________________________

City/Town: ____________________State: ___________Zipcode: __________________

Email:_______________________________________are you on our email list?___

If, not may we add your email?____How did you hear about this event?______________

Donated Work must be 8x10 or smaller and unframed; small 3D pieces will also be accepted.

Title:__________________________________ Medium:____________________

Size: height__________ width____________ depth (3-D)__________

Suggested value:______________

Do you wish to pick up your work if it does not sell? yes_______ no________

You must pick up your unsold work by Feb, 18^th or make special arrangements with us at drop-off.

Waiver

I, ____________________________, as artist and exhibitor at the 2012 Show of Hearts, understand that I am donating this work and will receive no compensation in return. I hereby waive, release, and discharge any claim I may have against Post Road Art Center for any and all damage to, theft of, or loss of my artwork. I do agree to hold Post Road Art Center free, harmless, and indemnified from any and all such claims therefore.

Signed:______________________________________Date:______________