|
NAME:
___________________________________________________________________________
|
|
ADDRESS:
____________________________________
CITY: ____________________________
|
|
STATE: ___________________
ZIP: _____________
COUNTRY: __________________________
|
|
HOME#
_________________
STUDIO/WORK# __________________ FAX # _________________
|
|
EMAIL:
________________________________ WEBSITE:________________________________
|
| -----------------------------------------------------------------------------------------------------------------
|
|
REGISTRATION CATEGORY (check one)
(
)Basic Level Free "Mini" Portfolio
( )Associate Level Free Portfolio
( )Professional Level Free Portfolio
( )Addition or change to existing Portfolio
|
Registration
Fee
Extra Images
Extra Text Pages
Update/Change
|
= FREE
$15 x _____ = ______
$15 x _____ = ______
$15 x _____ = ______
TOTAL = ______ |
(Only
digital images submitted as attachments to email or on disk
will be accepted,
NO Slides.)
|
| -----------------------------------------------------------------------------------------------------------------
|
|
PAYMENT TYPE
( )Check
or money order (payable to ISC in U.S. dollars only)
( )Please bill my (circle one):
VISA
|
MASTER
CARD
|
AMERICAN
EXPRESS |
Card
Number: ____________________________________ Expiration
Date: _______________
Signature: _______________________________________________________________________
|
| -----------------------------------------------------------------------------------------------------------------
|
|
RELEASE
I
permit the ISC to duplicate and release my images through the
Portfolio section of the ISC World Wide Web Internet site. I
agree to the terms described in this Portfolio Registration
Form and hereby submit my images for inclusion in Portfolio.
Inclusion in Portfolio does not constitute an endorsement of
my artwork by the ISC. The owners of the artwork retain all
rights, as allowed by law, to the sculpture represented in Portfolio.
Use of Portfolio is open to the public.
|
Signature: _________________________________________
Date:________________________ |
