|
1. Title of Exhibit ______________________________________________________ 2. Category:_____________________________ Brief Description of Exhibit: _____________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ 3. Size of exhibit:_____ pages, in_____ frames @ $_____ = _______ 4. Return: In person:_____ Method of return by mail: _________________________________________________ ________________________________________ Cost ____________________________________________ Total amount of frame fees and postage enclosed: ___________________________________________________ Delivery of Exhibit: In Person: __________ by mail: __________ 5. Youth Exhibitor: Birth date: ___________________________ 6. Society Memberships: ____________________________________________________ 7. Name of exhibitor: _______________________________________________________ 8. List Name in program? Yes _____ No _____ Pseudonym: ________________________ 9. Address of exhibitor: _________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 10. The undersigned agrees to abide by the rules for exhibiting, as listed on pages 1 & 2 of the Prospectus. Signature of exhibitor________________________________________ Dated ___________________________________________________ 11. Exhibit entry fee - from item 4 above. Amount: _________________ Stampers Dinner @ $21.00 - Friday, Sept. 21 No. _____ Amount _________ Awards Breakfast @ $17.00 - Sunday, Sept.23 No. _____ Amount _________ Total Amount Enclosed: $ ________________ In U. S. dollars - Payable to IEPS ) Do Not Mail Cash |