Mosaic Form"*" indicates required fields First name*Last name*Email* Phone*WebsiteInstagram and/or other Social Media presenceAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Do you plan to use 171's provided wooden panels?* Yes NoTheme: You are being asked to create up to sixteen, 6"x6" and/or 12"x12", artworks, and they must be created in response to a theme of your choosing.*Describe your theme in this space.Artist Bio: Tell us about you!*This information may be used for promotional purposes. Please be aware of spelling, grammar, and readability. (250 word limit, please)Gallery RepresentationIf you are represented by regional galleries, please list them here.Work Sample #1 Upload and describe your artwork. This image may be used for promotional purposes.File Upload - work sample #1*Max. file size: 256 MB.File Upload - Optional detail of work sample #1Max. file size: 256 MB.Work sample #1 Description of materials and techniques.*Include title, date created, and any other information to help explain your style or techniques.Work Sample #2 Upload and describe your artwork.File Upload - work sample #2*Max. file size: 256 MB.File Upload - Optional detail of work sample #2Max. file size: 256 MB.Work sample #2 Description of materials and techniques.*Include title, date created, and any other information to help explain your style or techniques.Work Sample #3 Upload and describe your artwork.File Upload - work sample #3*Max. file size: 256 MB.File Upload - Optional detail of work sample #3Max. file size: 256 MB.Work sample #3 Description of materials and techniques.*Include title, date created, and any other information to help explain your style or techniques.I agree to the following statements:I understand that 171 will provide wood panels at no charge, or that I may provide my own panels (for example, canvas and/or painting panels) at my expense. I understand all work must be available for sale. I understand that 171 retains 30% commission on all sales. I understand that 171 will not be responsible for loss or damage to work in transit to or from 171. I understand that if my work is not sold during the Exhibition that it must either be picked up, or it will be shipped back to me with the pre-paid UPS or FedEx return shipping label I've provided, at my expense. I understand that 171 will not be held responsible for loss, theft, or damaged work after 14 days of the last day of the Exhibition. I understand that in order to be paid for sales of my work that I must provide a current IRS Form W9 in advance of the exhibition. Upload the form to your computer by copying and pasting this link: https://www.irs.gov/pub/irs-pdf/fw9.pdf into your browser. I understand that 171 will collect and remit all applicable sales tax. I understand that 171 will mail payments from sales within 30 business days following the close of the Exhibition. YesPhoneThis field is for validation purposes and should be left unchanged.
