| LEGENDS, HEROES, and LEADERS EXHIBITION ONLINE ENTRY FORM |
| First Name Last Name Address City State Zip/Postal Code Country EMAIL: Very important, this is how we will inform you about the curator’s results. Phone How did you hear about this exhibition Please, be specific Number of Entries Entry Fee Total $ Non-refundable Entry Fees: $25 for up to three entries. $5 for each entry thereafter with a maximum of six entries total. I will mail entry fee DEADLINE FOR MAILING A CHECK IS MONDAY JANUARY 18, 2010 AFTER THIS DATE ONLY PAYPAL PAYMENTS WILL BE ACCEPTED check or money order payable to THE LoDi PROJECT send to: THE LoDi PROJECT, Attn. Exhibition Entries, 1126 North Blount Street, Raleigh NC 2760 or I prefer to use paypal (a link to PayPal will be provided upon submission of this form) I will be submitting my entries by Mail (CD or DVD) DEADLINE FOR MAILING A CD IS MONDAY JANUARY 18, 2010 AFTER THIS DATE ONLY EMAIL ATTACHMENTS WILL BE ACCEPTED or Email attachment send to: submissions@thelodiproject.com ___________________ ENTRY 1 Title: Medium: Size (hxw) or length of time of film/video Date Sale Price (not for video/film works) Insurance Value if NFS (not for video/film works) _____________________ ENTRY 2 Title: Medium: Size (hxw) or length of time of film/video Date Sale Price (not for video/film works) Insurance Value if NFS (not for video/film works)) ____________________ ENTRY 3 Title: Medium: Size (hxw) or length of time of film/video Date Sale Price (not for video/film works) Insurance Value if NFS (not for video/film works) ____________________ ENTRY 4 Title: Medium: Size (hxw) or length of time of film/video Date Sale Price (not for video/film works) Insurance Value if NFS (not for video/film works) ______________________ ENTRY 5 Title: Medium: Size (hxw) or length of time of film/video Date Sale Price (not for video/film works) Insurance Value if NFS (not for video/film works) _____________________ ENTRY 6 Title: Medium: Size (hxw) or length of time of film/video Date Sale Price (not for video/film works) Insurance Value if NFS (not for video/film works) _____________________ Double check the information you entered above. Clicking SUBMIT indicates that you agree with the conditions of entry and exhibit as outlined in the prospectus, and that you agree to make your work available should it be selected for exhibit. |
| If by some reason you are experiencing problems submitting the information above, you can always write it in an Email and send it to: georges@thelodiproject.com |
| THE LoDi PROJECT P.O. Box 27763 Raleigh NC 27611-5251 Tel (919) 827-0315 |
