2011 Annual
FALL ART EXHIBITION

REGISTRATION FORM

Please Print - Information MUST BE LEGIBLE

NAME_______________________________________________________________

STREET______________________________________________________________

CITY_______________________________________ZIP______________________

PHONE(________)_____________________________________________________

---- TITLE ---------------------------------- DIV ------- MEDIUM -------PRICE (*) --

1.___________________________________________________________________

2.___________________________________________________________________

3.___________________________________________________________________

4.___________________________________________________________________

5.___________________________________________________________________

(*) use NFS if Not For Sale

Please check appropriate box:

[   ]  CAL member
[   ]    non-member

Release of Liability

I hereby release the City of Cypress, Cypress Art League, Cypress Recreation & Park District and anyone associated with the exhibition from any liability due to theft or damage of any kind to works of art entered by me in the Annual Autumn Art Exhibition. I permit the use of this activity/event photography and/or videotaping for promotional use and/or the City of Cypress and/or the Cypress Art League websites. I have read and understand the entry guidelines.

____________________________________________________________________

       Signature                                                                                                Date

CLAIM RECEIPT

Artist's Name ____________________________________

ENTRY #1 ______________________________________

ENTRY #2 ______________________________________

ENTRY #3 ______________________________________

ENTRY #4 ______________________________________

ENTRY #5 ______________________________________