Please fill out the form in its entirety and sign. Mail the application to: VNY Fine Art Awards P.O. box 100-097 Brooklyn, New York, 11210 Tel: 212-502-0688 Name: __________________________________ Address: __________________________________ City: __________________________________ State: __________________________________ Zip: __________________________________ Phone: __________________________________     Entry 1   Medium: __________________________________ Size: __________________________________ Title: __________________________________     Entry 2   Medium: __________________________________ Size: __________________________________ Title: __________________________________     Entry 3   Medium: __________________________________ Size: __________________________________ Title: __________________________________     Entry 4   Medium: __________________________________ Size: __________________________________ Title: __________________________________     Entry 5   Medium: __________________________________ Size: __________________________________ Title: __________________________________

Participants have entered five slides entry fee $50 per slide. The entry fee in non-refundable. The decision by the panel of judges is final. The slides will not be returned. By signing below the artist agrees to the following.

I certify that the enclosed entry(s) are my original work, independently created, composed and executed. The work was created in the last two years (since October 2002) and has never won an award in any previous art competition. I agree to hold Valentine New York & VNY Fine Art Awards harmless against all claims and liabilities arising out of the consideration, display, publication, promotion or other use of the images.

Artist signature___________________________________________ Date: ____________________