PROVIDENCE GALLERY   Holiday Square Works Show 2011

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Artist's Name____________________________________________________________

Daytime Phone___________________________________________________________

Email (used daily)_________________________________________________________

Address_________________________________________________________________

1st art work        Highlight if selected

Title____________________________________________________________________

Medium_________________________________________________________________

Size____________________________________________________________________

Price___________________________________________________________________

2^nd art work        Highlight if selected

Title____________________________________________________________________

Medium_________________________________________________________________

Size____________________________________________________________________

Price___________________________________________________________________

3^rd art work         Highlight if selected

Title____________________________________________________________________

Medium_________________________________________________________________

Size____________________________________________________________________

Price___________________________________________________________________

I am consigning the above listed art works to be considered for selection in the Providence Gallery 2010 SQUARE WORKS HOLIDAY SHOW. I understand that I must pick up any of my non-selected works by Saturday, November 20^th, 2010 at 2pm. If I do not pick up my non-selected works by that time, I understand that Providence Gallery is not responsible for storage of such works. If any of my works are selected for the show, I will pick up any of my unsold work within the five working days following January 31^st, 2011. After February 7th, 2011 Providence Gallery is not responsible for storage of my unsold art work.

Artist signature______________________________________________Date_______________

FOR SELECTED WORKS................

I have selected the works highlighted above for inclusion in the December 2010 Holiday Square  Works Show. These works will be consigned to this gallery for sale until January 31^st  , 2011.

Gallery Representative________________________________________Date________________

CONTACT

Phone:      704-333-4535