Application Form

Name: _________________________________Date:__________

Contact Information:
Email: _______________________________________________

Phone: ________________________Cell:___________________

Website: _____________________________________________

Address: _____________________________________________

City:_____________________State:________________Zip:____

Artist Category (general) _____________________________________________
Medium Description: (brief description of style, technique, etc:
____________________________________________________________
Brief bio:_________________________________________________________

_________________________________________________________________

Liberty Bay Gallery

18830 Front Street Suite 103 PO Box 1072, (mailing address),

Poulsbo, WA 98370 360-930-0756