great river arts institute

H2O: Film on Water Entry Form

Please Complete this Form, Print, and Mail to:

H2O
GREAT RIVER ARTS
33 BRIDGE STREET
BELLOWS FALLS, VT 05101

Name:
Address:
Address 2:
City:
State/Province:
Zip:
Country:
Email:
Phone:
Cell Phone:
Title of Work:
Length of Work:
Format-Please Confirm Single Channel/DVD:
SASE Enclosed?:
Brief Description/Statement:
Artist's Educational Institution Affliation (if applicable):
Method of Payment:	CC Check Paypal