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2. Name of Artist*
4. Address*
6. City
7. Zip Code
9. Email Address*

   (For questions or notice of award, or potential sale of artwork)

10. Phone Number*

    (For questions or notice of award, or potential sale of artwork)

12. Your Affiliation with Madison Heights*

    Example: Resident, Student, Alumni, Employed at a Madison Heights Business, Etc. 

13. Are you able to drop off and pick up your art, to and from City Hall?*
15. Medium of Artwork being Submitted*
16. Dimensions of Artwork being Submitted*
18. Work may be offered for sale at the discretion of the Artist. Please indicate if you are interested in selling your item when you submit it for consideration. Prices or contact information will not be displayed only a notification under the name of the artist indicating the item is for sale.
20. Would you like to put your Artwork up for Sale?
    -- Select One --YesNo
21. What price are you asking for?
23. Submit photos of your Artwork!*
24. Submit photos of your Artwork!
25. Submit photos of your Artwork!
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field