9th Heart of Winter Art Show Participation Form
Macsherry Library Community Gallery
February 11th 2012      Contact - Sue-Ryn Burns  482 - 2985
Complete and return to;  Macsherry Library  112 Walton St.  Alexandria bay NY 13607
Name_________________________________________________________________

Address_______________________________________________________________

Daytime  Phone____________________ Evening Phone______________

VISUAL ART; Painting, drawing, mixed media, collage, photograph, or other flat wall mounted piece;

_______________________________________________________________________

Title_____________________________ Artists Name____________________________

Approximate size_________________________________________________________

3 DEMENSIONAL ART ;  Sculpture, wall hanging

Title ____________________________   Artists Name___________________________

Approximate size_________________________________________________________

       (        ) I do have my own display stand                (     )  I will need a display stand

Special Requirements;_____________________________________________________

HAIKU or POEM;

Title ______________________________ Author’s Name______________________

All Artwork will be retrieved from Macsherry Library during Library hours Monday February
21st and Wednesday February 23rd.

        I agree to defend save harmless and indemnify Macsherry Library, it’s directors, trustees,
volunteers, agents, and employees from any loss, cost, or damage by reason of personal injury
or property damage of whatsoever nature or kind, arising out of or as a result of, the use of the
 Macsherry Library Community Gallery, it’s employees, agents, or subcontractors.

        I have read and agree to the above contract

Signature;_______________________________________date____________________

Parent or Guardian’s Signature for participants under 18 years of age;

________________________________________________ date ___________________