Members Online Gallery Information Form
Please fill out the following information. Return the form by mail along with your chosen photos or image disk to Cyndi Bolt.
Name ________________________________________________________________
Business Name __________________________________________________________
Mailing Address ________________________________________________________
Phone Number, with area code ___________________________________________
E-mail address _________________________________________________________
Your Web site URL ______________________________________________________
Short description of your work:
* describe the medium, style or techniques used
* 25 words or less - we reserve the right to edit
* you should not repeat your name in the description as it will be listed in the address
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Media_________________________
____ my images are enclosed
Image # 1 Name & Description ________________________________________________
Image # 2 Name & Description _______________________________________________
Mail to : Cyndi Bolt, Route 2 Box 2417, Wayne, WV 25570
E-mail the text, saved as plain text, to: bolt3 @ marshall.edu (remove the spaces)
To ask questions: 304-849-4341 and ask for Cyndi Bolt
