2006 IPAT EXHIBIT PRE-REGISTRATION FORM
Three pieces will be accepted for Exhibition
MAIL THIS COMPLETED FORM To:
Pre-Registration Chairman: Mary Lynn Smith - %IPAT, Inc. - Grapevine, TX
76099
¨
Regular ¨
Student ¨
Experimental ¨
Student ¨
Youth Member ¨
Portrait Society Member
IF YOU ARE ENTERING A PIECE INTO COMPETITION, IT WILL COUNT AS ONE OF YOUR THREE
PIECES in the Exhibit.
You must present your current IPAT Membership Card when you enter your art into
IPAT Exhibits.
If piece is delivered by a friend, they must have your IPAT membership number.
Please print or type:
NAME :
________________________________________________________________________________
IPAT Membership # : __________________
ADDRESS:___________________________________________________________________________________________________________________
CITY: ____________________________________________________________________
STATE/PROV: ______________________________________
COUNTRY: ________________________________________ ZIP/POSTAL CODE:____________
Mark appropriate boxes below:
1. Has this pieces been photographed at a previous show/ convention?
¨
YES ¨
NO
2. Has this piece been submitted to another magazine for possible publication?
¨
YES ¨
NO
3. IPAT, Inc. has my permission to photograph my art. The PORCELAIN ARTIST
magazine has my permission to publish photos of my work with or without
ribbons. ¨YES
¨
NO
Title of piece:
_________________________________________________________________________________________________________________
Size /
Description:_____________________________________________________________________________________________________________
I have read and agree to the rules of IPAT, and will not hold IPAT, Inc., the
photographer or any IPAT member responsible for accidental breakage, damage and
/ or loss. SIGNATURE
:___________________________________________________________________
Date:_____________
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