Artist Directory Submission Form

Artist is a*

Are you at least 18 years of age?

Name

First Middle Last

Address

Street Address Address Line 2 City State

Phone Number

Artist Website

Artist First and Last Name for Publication*

Email

Artist Phone Number

Artist Email

Do you have a current Silver Hand Permit?

If yes, what is your Silver Hand Permit number?

Primary Mediums

Briefly introduce yourself and summarize the type(s) of artwork you create

Discount provided to (please check all that apply):

Discount Description

Image