Application Form

Crosstie Arts and Jazz Festival
PO Box 1064
Cleveland, MS 38732-1064

Name________________________________

Address____________________________

City_________________State_____

Zip_______________Phone________________

e-mail______________________________Fax________________________________

Type of work exhibited__________________________________________

Checklist

chkbox.gif (1052 bytes) Application Form
chkbox.gif (1052 bytes) Check for $75.00
chkbox.gif (1052 bytes) Legal SASE
chkbox.gif (1052 bytes) Current membership in _________________________ Chaftsmen’s Guild or
chkbox.gif (1052 bytes) Three photos/slides of work

General Release

The undersigned does hereby and forever discharge the Crosstie Arts Council, Inc. of and from all manner of actions, suits, damages, claims, and demands whatsoever in law or equity from any loss or damage to the undersigned’s property while in the possession, supervision or auspices of the Crosstie Arts council, Inc., its agents, representatives or employees.

__________________________________________

Applicants signature

 For More Information Call Anne Koonce, Exhibitor Coordinator, 662-843-2393, or mail to, Crosstie Arts Council, PO Box 1064, Cleveland MS 38732-1064 or e-mail Anne Koonce