Art Residency Publicity Consent Form
Please provide your information and consent for the use of your image, artwork, and related details in publicity materials for the art residency.
Participant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Title of Artwork or Project
Please specify any limitations or preferences regarding the use of your image, artwork, or information (optional)
Date of Consent
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature (Please sign to confirm your consent)
*
Submit Consent
Submit Consent
Should be Empty: