Entry Form

This is to certify that my entry in Thacker-Grigsby's Directory Cover Contest is an original of my own creation, neither copied nor duplicated from any previously published art including paintings or published photographs or a family heirloom that I own and /or have permission to enter in this contest.  In addition, I understand that if my artwork is judged as the winning entry, Thacker-Grigsby Communications will assume reproduction rights and I must provide the original photo.

 
Name:__________________________________________________________________________________________________________
 
Street Address:___________________________________________________________________________________________________
 
Mailing Address:_________________________________________________________________________________________________
 
City, State and Zip:_______________________________________________________________________________________________
 
Home Phone Number:_____________________________________________________________________________________________
 
 Daytime Phone Number:___________________________________________________________________________________________
 
 Signature:_______________________________________________________________________________________________________
 
 
 Please give us some information about your picture in 100 words or less.  Who, What, When Where, Why, etc.