Artist Entry Form
Presented by the Mira Mesa Women’s Club
Saturday, May 9, 2009, 9am - 2pm
Mira Mesa Recreation Center
Yes, Sign me up!
Artist Information:
Artist’s name: _____________________________________________
Address: _________________________________________________
City/State/Zip: _____________________________________________
Phone: ___________________________ Email: ___________________________________________________
(If applicable) School: _______________________________________ Grade: ____________________________
I understand I need to have a sponsor. I am sponsored by:
_________ Myself ($10.00 for a 3x3 square). You do not need to submit a Sponsor Form - just this Artist Entry Form.
Make check payable to Mira Mesa Women's Club.
_________ My Family ($10.00 for a 3x3 square). You do not need to submit a Sponsor Form - just this Artist Entry Form.
Make check payable to Mira Mesa Women's Club.
_________ Organization or Business (a Sponsor Form must be submitted,which is available on the website
http://www.mmwomensclub.com in the Chalk The Walk section.).
_________ I need a sponsor.
Sponsor Information for the organization, business or person sponsoring me:
Name of Sponsor __________________________________________________________________
Mailing ddress ____________________________________________________________________
City ______________________________________State ___________Zip ______________________
Telephone: _________________________ Email: ________________________________________
Artist Disclaimer*
I, the undersigned artist(s) (guardian if under 18), acknowledge the following:
I have read the above and agree to abide by the Artist Disclaimer.
Signature _______________________________________________Date _____________
Guardian Signature _______________________________________Date ______________
Mail to: For more information:
Mira Mesa Women’s Club Email: mmchalkthewalk@yahoo.com
P.O. Box 26013 Dyanna Smith (858-578-1416)
San Diego, CA 92196 Martha Pritchard (858-566-
8847
Website: http://www.mmwomensclub.com
Presented by the Mira Mesa Women’s Club
Saturday, May 9, 2009, 9am - 2pm
Mira Mesa Recreation Center
Yes, Sign me up!
Artist Information:
Artist’s name: _____________________________________________
Address: _________________________________________________
City/State/Zip: _____________________________________________
Phone: ___________________________ Email: ___________________________________________________
(If applicable) School: _______________________________________ Grade: ____________________________
I understand I need to have a sponsor. I am sponsored by:
_________ Myself ($10.00 for a 3x3 square). You do not need to submit a Sponsor Form - just this Artist Entry Form.
Make check payable to Mira Mesa Women's Club.
_________ My Family ($10.00 for a 3x3 square). You do not need to submit a Sponsor Form - just this Artist Entry Form.
Make check payable to Mira Mesa Women's Club.
_________ Organization or Business (a Sponsor Form must be submitted,which is available on the website
http://www.mmwomensclub.com in the Chalk The Walk section.).
_________ I need a sponsor.
Sponsor Information for the organization, business or person sponsoring me:
Name of Sponsor __________________________________________________________________
Mailing ddress ____________________________________________________________________
City ______________________________________State ___________Zip ______________________
Telephone: _________________________ Email: ________________________________________
Artist Disclaimer*
I, the undersigned artist(s) (guardian if under 18), acknowledge the following:
- The art I create must be suitable for general public viewing
- Mira Mesa Women’s Club is entitled to photograph the art work and/or artist and use it for any
- Sidewalk Chalk will be provided. No paints, liquid chalk, or fixatives can be used.
- I will be courteous, friendly and helpful to fellow artists and members of the public.
- I release Mira Mesa Women’s Club, all sponsors, organizations, and individuals involved in the
I have read the above and agree to abide by the Artist Disclaimer.
Signature _______________________________________________Date _____________
Guardian Signature _______________________________________Date ______________
Mail to: For more information:
Mira Mesa Women’s Club Email: mmchalkthewalk@yahoo.com
P.O. Box 26013 Dyanna Smith (858-578-1416)
San Diego, CA 92196 Martha Pritchard (858-566-
8847
Website: http://www.mmwomensclub.com
