MOBICON Art Show Registration

Artist:		Agent:
Address:		Address:
City:		City:
State:	Zip Code:	State:	Zip Code:
Phone:		Phone:
E-Mail:		E-Mail:
Website:		Website:

Is this a new address? YES NO

Which is the best way to contact you? Phone E-Mail Snail Mail

Do you wish to be notified if we have vacant space as of May 1^st? YES NO

Do you have any special display needs (i.e. electricity)? YES NO

Do you wish to sell your work in the after auction Minimum Bid sale? YES NO

Are you sending any work for the charity auction? YES NO

May Mobicon take photos of your work for future Art Show promotion? YES NO

May the press take photos of your work for journalistic purposes? YES NO

Do you want your packing material returned if all work is sold? YES NO

How do you want unsold art returned? U.S. Postal Service UPS FedEx Other __________________

Do you want your return art shipment insured for the value of the art? YES NO

Make payment check payable to: __________________________________________________________

		Staff Use Only Check Number
Panels (4’x 4’) @ $15.00 each, maximum 2	$
Bays (3 panels in U) @ $40.00 each, maximum 1	$
Tables (2’ x 5’) @ $10.00 each, maximum 2	$
Half Table (2’ x 2’) @ $6.00	$
Combination display @ $20.00, maximum 2	$
MOBICON T-Shirt @ $15.00 each	$
Mail-in Artist handling fee $5.00	$
Total:	$

Please make checks/money orders payable in U.S. Dollars to MOBICON.

Mail Registration Form & Payment to:	Mail Art to:
MOBICON Attn: Art Show P.O. Box 161632 Mobile, AL 36616-2632	MOBICON Art Show C/O Wayne Hergenroder 4267 Aldebaran Way Mobile, AL 36693

I have read and agree to all rules of the MOBICON Art Show.

Printed Name:

Signature:

Date: