FLAGLER COUNTY ART LEAGUE SHOW REGISTRATION
NAME OF SHOW________________________________________________
Complete the following information and send it along with your non-refundable entry fee by either
check, money order or complete credit card information to:
FCAL
Attn: FCAL Show Entry Form
P. O. Box 352772
Palm Coast, FL 32135-2772
Artist:___________________________ Phone:_________________________
Email:__________________________________________________________
ENTRY A: Title:________________________________________________
Size:____________________ Medium:______________ Price:____________
ENTRY B: Title:_______________________________________________
Size:____________________ Medium:______________ Price:____________
ENTRY C: Title:_______________________________________________
Size:____________________ Medium:______________ Price:____________
Credit Card Number (Accepting Visa or MasterCard only):
______________________________ Expiration Date:____________________
Billing Address: __________________________________________________
I am a current member of FCAL: Yes No
I understand my entry submission constitutes an agreement to comply with all
conditions set forth in the Prospectus and will hold harmless FCAL for any loss or damage to my
artwork.
SIGNATURE:_______________________ DATE:______________