Please print or type.

  Name:                                                                                                              

  Address:                                                                                                           

  Phone:                                                                                                              

  E-mail:                                                                                                              

  Homepage:     http://                                                                                        

Entry

File Name

Title

Medium

Size

Date

Price

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     I accept the terms of this prospectus. I authorize Guests Gallery to post my work on the web site and to be

used for  promotional purposes.

                              Signature & Date:   

   Send to  :    Guests Gallery

                       P. O. Box  195

                       Lilburn, GA 30048

                       Attn: Art Market Gallery