AFP Competition Registration - Printable Form

Please print this form and fill in the information below. All fields are required.

You may pay via check or money order as well as by credit card.

Name:
Address:
City:
State:
Zip Code:
Phone:
Email:
How Did You Hear About Us?:
Please Select The Category You Wish To Enter:
	Visual Artists - gif, jpg
	DJs - wma, wav, mp3 (60 min mix)
	Live Music - wma, wav, mp3
	Fashion Designers - gif, jpg
	Short Films - avi, mpeg/mpg, wmv/asf, mov
	Creative - avi, mpeg/mpg, wmv/asf, mov, wma, wav, mp3, gif, jpg
Submission Information (title, medium, year, length, etc):
Name on Credit Card:
Credit Card Type:	MasterCard  Visa  Amex or  Discover
Credit Card Number:
Credit Card Expiration Date:
Credit Card Security Code:
I authorize you to charge the above credit card for $30.
Your Signature:

Please send a CD with up to 3 of your works to "Art For Progress" to:

Art For Progress
151 First Ave, #26
New York, NY 10003