A Night for the Arts Submission Form
Dear Patients and Friends,

Thank you for expressing interest in our first annual 'A Night for the Arts' on Wednesday, February 7, 2018 from 5-7pm. Bring your family and friends to our office for a night of celebrating your artistic achievements and mingling with fellow artists.

We are looking forward to showcasing your art in our office! All artists of all ages are welcome to submit their work for display; painter, photographer, sculptor, cartoonist, architect, etc. Please see the guidelines below about piece submission and then fill out this form. Feel free to contact Tim Kelly at Tim@drforlano.com or 631-581-5121 with any questions or concerns.

1. Artists can submit one piece or a series of their work for display. We will be proud to display all work submitted.

2. Artists can drop off their works starting on Monday, January 15, 2018. The office will be open during the following hours: Mondays 11am-7pm, Tuesdays 8am-2pm, Wednesdays 11am-7pm, Fridays 8am-2pm. If you need to make other drop-off arrangements, please contact the office. We will be happy to work with you to find a suitable time.

3. After the show, artists will be able to pick up their artwork starting Monday, February 12. Please see the office hours listed above.

4. Below, you will see six slots for your art work submissions. If you are submitting one piece, please use the first slot and leave the others blank. If you need more slots and wish to submit more than six pieces, please contact Tim.

5. If you have easles or other devices to help display your work, we would greatly appreciate being able to borrow them for the night. All items and pieces will be returned.

Thank you for your dedication to the arts; the office can't wait to see your work!

Best always,
Tim Kelly

Artist's Name *
Your answer
Email Address
Your answer
Phone Number
Your answer
Website (optional)
Your answer
Piece #1
Title
Your answer
Size
Your answer
Medium (e.g. oil on canvas)
Your answer
Special Instructions and Notes (handling, storing, hanging...)
Your answer
Piece #2
Title
Your answer
Size
Your answer
Medium (e.g. oil on canvas)
Your answer
Special Instructions and Notes (handling, storing, hanging...)
Your answer
Piece #3
Title
Your answer
Size
Your answer
Medium (e.g. oil on canvas)
Your answer
Special Instructions and Notes (handling, storing, hanging...)
Your answer
Piece #4
Title
Your answer
Size
Your answer
Medium (e.g. oil on canvas)
Your answer
Special Instructions and Notes (handling, storing, hanging...)
Your answer
Piece #5
Title
Your answer
Size
Your answer
Medium (e.g. oil on canvas)
Your answer
Special Instructions and Notes (handling, storing, hanging...)
Your answer
Piece #6
Title
Your answer
Size
Your answer
Medium (e.g. oil on canvas)
Your answer
Special Instructions and Notes (handling, storing, hanging...)
Your answer
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