Please fill up this form and return with your artwork(s) to the address indicated below by November 30th 2017

Valeria ArtLab

8362 Paluxy Dr., Tyler TX 75703

Please print neatly as all information must be legible

Artist’s name____________________________________________________          Phone___________________________________

Artist’s address_______________________________________________________________________________________________          

School_______________________________________________________________________________________________________

Grage/Age___________________________________________________________________________________________________

Email_______________________________________________________________________________________________________

Total Entries___________ ($8.00 / entry)                                        Total amount Enclosed______________________________________

Entry #                      Title of Entry                             Media                         Entry size                                School                         Grade/Age

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Parent’s or legal guardian’s Signature: ______________________Print your name: _____________________________ Date:_______________

Signing this form, you confirm your contribution to the project Russians For Americans. You give your permit to Valeria ArtLab (USA) and The Children Center “Strekoza” (Russian Federation) to use the artwork(s) of your child, and understand that the image of the artwork can be printed, awarded, or sold for the project purposes. However, the author’s rights for the image of the artwork will still belong to its author, i.e. your child, and the organizations will keep the name of Artist connected with the artwork.