MILLENNIUM PHILCON ART SHOW
REGISTRATION FORM

This form prints as two pages and both pages are needed for the form to be accepted.
Artist's Name:___________________________________
Address:_________________________________________
_________________________________________
Phone___________________________________________
E-Mail__________________________________________
Social Security #_______________________________
Agent's Name:___________________________________
Address:________________________________________
_________________________________________
Phone___________________________________________
E-Mail__________________________________________
Artist's Website url:___________________________
Pro [ ] Amateur [ ] Semi-Pro [ ]

Number of Panels Required: (Max. 3 units)
Full (4' x 6'):____________
Half (4' x 3'):____________

Number of Tables Required: (Max. 2 units)
Full (6' x 30"):_____________
Half (3' x 30"):_____________

Maximum combined units: 3.
$60 = 1st unit, $65 = 2nd unit, $ 70 = 3rd units
$30 = 1/2 unit
Number of Pieces for Sale____________
Number of Pieces NFS_______________
Print Shop: $1.00 per print
# images#copiesdimensionstotal #
_______ x _____________"x______"= ________
_______ x _____________"x______"= ________
_______ x _____________"x______"= ________
_______ x _____________"x______"= ________
_______ x _____________"x______"= ________
_______ x _____________"x______"= ________
_______ x _____________"x______"= ________
_______ x _____________"x______"= ________
_______ x _____________"x______"= ________
_______ x _____________"x______"= ________
_______ x _____________"x______"= ________
Total= _________
All prints will be displayed in and sold through the Print Shop. No prints will be allowed in the auction.

Any Special Display Requirements___________________________________________________________________

_______________________________________________________________________________________________

[ ] I want an artist table in the art show. I understand that I can not sell merchandise from this table.

Time Constraints___________________________________________________________________________________

[ ] I Will Be Attending the Millennium Philcon. [ ] Send 6 Page Flyer with Reg. Info

[ ] I Cannot Attend in Person But Authorize ________________________________________To Be My Agent.

Address___________________________________________Telephone____________________________________

City_______________________________________State_________________Zipcode________________________

[ ] I Cannot Attend in Person But Wish to Mail In My Art. Contact Art Show Directors for required approval.

Maximum of 1 Panel (4' x 6') or 1/2 Table or 4 Print Images/20 Copies Total Per Mail-In Artist.

 
$_____ Art Show Fee (total panels & tables)
$_____ Print Shop Fee ($1 per copy)
$_____ Mail-in fee ($40 if permitted)
$_____ Membership(s) (_____*@ $_______________)
$_____ Total Amount

*Include name & address for addt'l. members on separate sheet.
[ ] MasterCard [ ] Visa [ ] Amex Exp. ____/_____
Card#________________________________________
Name on Card:_________________________________
Signature______________________________________
[ ] Check /MO made out to Millennium Philcon
[ ] Refund if no space available
[ ] Wait list for available space

Please Return This Form ASAP but No Later Than July 15, 2001, to:

Barbara Higgins 1011 New Hope St.,19B, Norristown, PA 19401
Phone (Eve) (610) 239-6763, E-mail: higgins@cyber.com

I Have Received the 7-Page Millennium Philcon Art Show Rules and Agree to Abide by Them

Signature of Artist____________________________________________________ Date_________________

This form prints as two pages and both pages are needed for the form to be accepted.