Please print or type.

  Name:                                                                                                    

  Address:                                                                                                

  Phone:                                                                                                  

  E-mail:                                                                                                   

  Homepage:     http://                                                                            _             

Entry

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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:

        Deadline :  February 24, 2012 (postmarked),    February 29, 2012 (online) 

   Send to  :    Guests Gallery

                      P. O. Box  195

                      Lilburn, GA 30048

                      U. S. A.