Submission form

Share your Beaver Creek Fire Images An open exhibition Hosted by: Environmental Resource Center & Idaho Conservation League October Gallery Walk: October 11, 2013

SUBMISSION FORM Deadline: 5:00pm Friday, October 4, 2013. (Please call in advance as we are a small staff and not always on site.)

Name: _________________________________________________

Mailing Address: _________________________________________________

City, State, Zip: _________________________________________________

Email: _________________________________________________

Daytime Phone: _________________________________________________

Title of Submission: _________________________________________________

Ensure that your name and title of your submission are affixed to the back of your framed photograph.

Signature* and date (month, day, year):

*Signature acknowledges agreement to the conditions stated in the Submission Guidelines and Submission Details.