International Sculpture Center
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PORTFOLIO REGISTRATION FORM

NAME: ___________________________________________________________________________

ADDRESS: ____________________________________   CITY: ____________________________

STATE: ___________________ ZIP: _____________   COUNTRY: __________________________

HOME# _________________  STUDIO/WORK# __________________ FAX # _________________

EMAIL: ________________________________  WEBSITE:________________________________

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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.)

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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: _______________________________________________________________________

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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:________________________

Please return this completed form, together with your supporting materials to:

ISC Headquarters and Resource Center
Portfolio Department
14 Fairgrounds Rd., Suite B
Hamilton, NJ 08619-3447
Phone: (609) 689.1051 x131 Fax: (609) 689.1061
portfolio@sculpture.org