ARTIST ……………………………………………………………………………………………………..……………………............................... 

ADDRESS……………………………………………..……………………………………………………………….……….. ...............................

DAY PHONE………………….……..…………….. EVENING PHONE………………………………………….…………

EMAIL……………………………………..………... YOUR WEBSITE………………………...………………………..…..

GALLERY WEBSITE(s) …………………..............………………             …………………………………………………………...

ART WORKS IN GALLERY:

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I certify the above to be correct and agree to comply with Eastrose Gallery regulations and  procedures.

WEBSITE: I would like images of my artwork to appear on the Eastrose Gallery website.   ..…Yes  ..... No
Biography or artistic statement:  ……Yes   …..… No

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Date                              .......................          Artist Printed Name                                        Artist Signature

DATE WORK RECEIVED: ………………………………..…………….    ARTIST'S INITIALS…………………

DATE WORK RETURNED: ………………………………..…….…….     ARTIST'S INITIALS…………………