Electronic MASF Show Entry Form

  Note: Your Name entry has been re-arranged to better suit our processing needs         
Name Prefix
Mrs., Dr., etc.
 
First Name
 
MI
 
Last Name
 
Name Suffix
Jr., II, etc.
 
Honorary
Member
User ID:
Address 1 Address 2 City State/Province

     
Country Postal Code Telephone Number E-mail Address

       
Check if you are in the age
range of 18 to 35 years
       
Check if you are a
first time entrant
       
Check if there is an
alternate shipping address
       
Check if you want to
be paid via PayPal

   
Artwork Title
Substrate Used or
Material for Sculpture
Media
Letters
Category
Letters

Price
1                       $          
2                       $          
3                       $          
4                       $          
5                       $          
6                             $          

         Entry Fee   $                    Credit Card Information (Visa or Master Card Only)
Credit Card Fee (If applicable) $ Credit Card Number_____________________________________ Exp Date______
Shipping and Handling $ Security code (3 or 4 digit in signature space on back of card) [Required!]________
Additional Insurance (Optional) $   Note: The value you entered has been rounded down to the nearest whole dollar     Amount (US$)________ Name (as it appears on card)________________________
Membership Dues (Optional) $ Signature:__________________________
Donation (Optional) $   Note: The value you entered has been rounded down to the nearest whole dollar     Write credit card information and signatures on printed form.
Total Amount Paid $      
Check Number I hereby attest to having read the MASF Show prospectus and agree to
all the terms and conditions therein.
                     Signature:__________________________
                         
                         
Alternate
Shipping
Address:
 
      Name     
Street
Address
City
  State Country
Zip Phone                    Tags (below) will
print on a second page.
E-mail
                                                   
  Cut out tags and attach to backs of works.       Caution: Data cannot be entered into tags
  1-       Age<36                 1st Time                 
  Artist:  
  Med   Cat   Price $
  Title:
  2-       Age<36                 1st Time                 
  Artist:  
  Med   Cat   Price $
  Title:
  3-       Age<36                 1st Time                 
  Artist:  
  Med   Cat   Price $
  Title:
  4-       Age<36                 1st Time                 
  Artist:  
  Med   Cat   Price $
  Title:
  5-       Age<36                 1st Time                 
  Artist:  
  Med   Cat   Price $
  Title:
  6-       Age<36                 1st Time                 
  Artist:  
  Med   Cat   Price $
  Title: