CONE Health Art form Please enable JavaScript in your browser to complete this form. – Step 1 of 2Artists, please fill out all *required information Artists Contact information *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Phone *Artist Statement (optional)Why is this project important to you (optional) Entry #1 Image of Entry #1 * Click or drag a file to this area to upload. Medium of Entry #1 *Dimension Category of Entry #1 *2-D SMALL (18” x 24” min, 35” x 35” max)2-D LARGE (36” x 36” min, 48” x 48” max)2-D EX-LARGE (48” x 72” and 60” x 92” roughly)3-D Flatware/plates (4” – 12” diameter)3-D Pots/vessels (up to 7” wide and up to 12” tall)3-D Featured pottery (up to 1’ wide x 2’ tall)3-D Outdoor pottery/sculpture (min height 32”)Exact dimensions (open answer) Width *Height *Depth *Title *Entry 2 Image of Entry #2 Click or drag a file to this area to upload. Medium of Entry #2Dimension Category of Entry #22-D SMALL (18” x 24” min, 35” x 35” max)2-D LARGE (36” x 36” min, 48” x 48” max)2-D EX-LARGE (48” x 72” and 60” x 92” roughly)3-D Flatware/plates (4” – 12” diameter)3-D Pots/vessels (up to 7” wide and up to 12” tall)3-D Featured pottery (up to 1’ wide x 2’ tall)3-D Outdoor pottery/sculpture (min height 32”)Exact dimensions of Entry #2 (open answer) Width Height Depth Title of entry 2Entry 3 Image of Entry #3 Click or drag a file to this area to upload. Medium of Entry #3Dimension Category of Entry #32-D SMALL (18” x 24” min, 35” x 35” max)2-D LARGE (36” x 36” min, 48” x 48” max)2-D EX-LARGE (48” x 72” and 60” x 92” roughly)3-D Flatware/plates (4” – 12” diameter)3-D Pots/vessels (up to 7” wide and up to 12” tall)3-D Featured pottery (up to 1’ wide x 2’ tall)3-D Outdoor pottery/sculpture (min height 32”)Exact dimensions of Entry #3 (open answer) Width Height Depth Title of entry #3Entry 4 Image of Entry #4 Click or drag a file to this area to upload. Medium of Entry #4Dimension Category of Entry #42-D SMALL (18” x 24” min, 35” x 35” max)2-D LARGE (36” x 36” min, 48” x 48” max)2-D EX-LARGE (48” x 72” and 60” x 92” roughly)3-D Flatware/plates (4” – 12” diameter)3-D Pots/vessels (up to 7” wide and up to 12” tall)3-D Featured pottery (up to 1’ wide x 2’ tall)3-D Outdoor pottery/sculpture (min height 32”)Exact dimensions of Entry #4 (open answer) Depth Height Width Title of entry #4Entry 5 Image of Entry #5 Click or drag a file to this area to upload. Medium of Entry #5Dimension Category of Entry #52-D SMALL (18” x 24” min, 35” x 35” max)2-D LARGE (36” x 36” min, 48” x 48” max)2-D EX-LARGE (48” x 72” and 60” x 92” roughly)3-D Flatware/plates (4” – 12” diameter)3-D Pots/vessels (up to 7” wide and up to 12” tall)3-D Featured pottery (up to 1’ wide x 2’ tall)3-D Outdoor pottery/sculpture (min height 32”)Exact dimensions of Entry #5 (open answer) Width Height Depth Title of entry #5NextArtists Agreement Authenticity The image(s) entered are of your own personally handcrafted, original artwork, created by yourself, the artist. You the artist is the sole proprietor of all rights in and to the work submitted. The work submitted is original and contains no material from other copyrighted or unpublished works. No commercially produced (created and/or assembled by another company or organization or individual) items are accepted. Exhibition Artist name and details of artwork submitted will be publicly displayed in the Cone Health MedCenter Asheboro. (Artist phone number and address will not be shared with the public.) 3.Payment Payment will be issued for each SELECTED art piece based on the dimensions listed in the information page of this application. Payment, in the form of a check, will be mailed from the Randolph Arts Guild upon the completion of a W9 Form and within 10 business days after art is received. Artwork If selected, artwork must be ready to frame and in a state/condition reflecting the submitted artwork photos in this application. The condition of the art piece shall be inspected upon delivery to the Randolph Arts Guild to ensure it is representative of the submitted photo(s). Ownership All rights and interests of any kind, including copyright, of the selected artwork shall pass to the Owner (Cone Health MedCenter Asheboro) upon delivery of work and payment due to the artist.The artist does hereby relinquish, without restrictions or limiting conditions, the entire right, title and interest in the work selected. Sign and DateSubmit
