Name
Guardian's name, if entrant is under age
Name of representative and the number of people (If you entry as a group) |
Address
City:
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State/Province
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Country:
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Zip-code:
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Country Code |
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| TEL |
( |
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| FAX |
( |
) |
- |
-
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E-mail
@
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Entry Category (Select one)
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Quilt Tapestry |
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Colors of Living |
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Massage Quilt |
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Future Quilter |
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Around the World with Quilt |
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Title of Quilt
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Size
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Artist's Statement
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Insurance amount
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Credit Card
Select your card type
and f i l l out al l necessary informat ion. Your entry cannot
be accepted wi thout complete credi t card informat ion.
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VISA |
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MASTER |
Card number:
Name on Card:
Cardholder's signature
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