ENTRY FORM
2009 ARTISTS OF THE MOHAWK-HUDSON REGION

Please print this form, fill out completely. Enclose with CD or DVD and $20 check payable to
The University at Albany Foundation. Mail to: University Art Museum, UAlbany, 1400 Washington Avenue, Albany, New York 12222 / Attn: M-H Regional.

Make a copy of this Entry Form for your records. Be sure each image on the CD corresponds with the artwork listed below.

PLEASE PRINT CLEARLY!

Artist Name___________________________________________________________________________________

Address______________________________________________________________________________________

City_____________________________________ State____________________________ Zip________________

Phone___________________________________ Email address_________________________________________

[ ] I would like to be included on the UAM email list to receive notification of exhibitions and programs.

	Title	Date	Value
	Medium	Size
	Title	Date	Value
	Medium	Size
	Title	Date	Value
	Medium	Size
	Title	Date	Value
	Medium	Size
	Title	Date	Value
	Medium	Size