(NOTE: Download, fill in, save as Healing Plants_your name and RETURN WITH YOUR DIGITAL

ENTRY to exhibits@botanicgardens.org,)

ENTRY FORM
HEALING PLANTS
JUNE 30 SEPTEMBER 2, 2012
Venue: Parker Adventist Hospital, Parker, CO
Submission Deadline: May 29, 2012
ARTIST NAME:__ ________________________________________
ADDRESS:___________________________________________________________
CITY:_____________________________

STATE: _______

ZIP CODE: ________________

PHONE:______________________________
E-MAIL:____________________________________________________________
ARTWORK TITLE____ ________________________________
MEDIUM:___ _____________________
SALES PRICE: $ _____ NOT FOR SALE:____

I hereby freely grant Denver Botanic Gardens and its representatives permission to hang the
above named artwork during the exhibit at Parker Adventist Hospital, Parker, CO, and
permission to publish photographs taken of my original artwork, which must include artist
credits whenever used, for editorial, advertising, commercial, educational or display purposes.

_______________________________________
Your Name

_______________
Date

Payment Method - fill in or call 720-865-3653 (Entry fee $20) :

MasterCard American Express Visa
Card # _____________________________ Exp Date ___________ CVV______
Signature________________________________________________