Application for Jurying

Kanata Civic Art Gallery
2010

Please print clearly

NAME: _________________________________________________________

ADDRESS: ______________________________________________________
 
PHONE: ______________________home__________________________work

E-MAIL: ________________________________________________________

TYPE OF ART WORK FOR JURYING: ______________________________

Please sign the following statements to indicate your concurrence:

I certify that the work I am submitting to be juried and exhibited is original work completed by me, not from patterns or completed under instruction.

I release the City of Ottawa from any responsibility in the event of fire, theft, damage or loss.

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                        Your signature                                                                          Date