| Artist: _________________________ | Agent: _________________________ |
| Address: _______________________ | Address:_______________________ |
| City:__________________________ | City:__________________________ |
| State/Zip:_______________________ | State/Zip:_______________________ |
| Phone: ________________________ | Phone:________________________ |
| E-mail:_________________________ | E-mail: _________________________ |
| IS THIS A NEW ADDRESS? ____ |
Do you need additional control (listing) sheets for the Art Show? How many?____
For the Print Shop? How many?______
Approximately how many pieces are you showing?_________
| ___ Panels (4' x 4') @ $15 for 1, maximum 4 | $________ |
| ___ Tables (6') @ $10 for 1/2, $15 for 1, maximum 2 | $________ |
| ___ Prints @ 1 -5 prints $5; 6-10 prints $10; 11-15 prints $15; 16-20 prints $20, maximum 20 | $________ |
| TOTAL AMOUNT DUE | $________ |
Make checks and Money Orders payable to "FACT/ArmadilloCon 24"
Card type: (circle one) MasterCard Visa Discover AmEx
Card number ___________________________________________________
Expiration date ____________________ Phone ____________________
Name on the card _______________________________________________
Signature _____________________________________________________
PLEASE NOTE: CREDIT CARDS WILL BE RUN THROUGH THE ACCOUNT OF "ADVENTURES IN CRIME & SPACE", SO THE CHARGE FOR ART SHOW FEES ON YOUR BILL WILL BE TO THAT BUSINESS. By signing, you allow "Adventures in Crime & Space" to charge your credit card the amount specified above.
I may be contacted at 512-323-6648 (evenings/weekends before 11pm CST are best), or via email at chelsea@io.com. I am willing to answer any questions you may have, but I need to have your payment in order to guarantee your space at the show. Do you have any special needs for space, electricity, etc.? Has your name changed? Please let me know: