Gallery 57 West Commission Registration

Artist Name *

First

Last

Phone *

Email *

Artist Website

Artist Social Media Account(s)

Entry 1 Title, Medium, Price, Dimensions *

Pieces must be priced with one of the following prices: $50, $100, $175, $200, $225, $300, $350, $400, $450, $500, $550, $600, $650, $700

Entry 2 Title, Medium, Price, Dimensions

Pieces must be priced with one of the following prices: $50, $100, $175, $200, $225, $300, $350, $400, $450, $500, $550, $600, $650, $700

Comments / Notes

Signature