ENTANGLED Collaboration Intent to Submit

INTENT TO SUBMIT

(open from Mar 1 through August 15)

Women in the Visual and Literary Arts

ENTANGLED Collaboration

Following this informational page, there is a payment form in which to submit the $80 or $120 ($40 per team member) entry fee. You must pay for all team members when you submit this form. Your Intent to submit is not final until payment is received.

You must be a paid member of WiVLA before you can submit this form. If your membership is not current, you can renew it online at www.wivla.org. Send any questions concerning membership to membership@wivla.org.

Personal Information for 1st Partner

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Email Address *

Preferred Phone Number *

WiVLA Membership Current? *

Yes

Personal Information for 2nd Partner

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Email Address *

Preferred Phone Number *

WiVLA Membership Current? *

Yes

Personal Information for 3rd Partner (if applicable)

First Name

Last Name

Street Address

Address Line 2

City

State

Zip Code

Email Address

Phone Number

WiVLA Membership Current?

Yes

Provide a brief description of the Collaboration idea.

Write a brief (non-binding) description of the idea that your team intends to submit for Entangled. You can refine your idea as you work together on this project.

ENTANGLED Collaboration Intent to Submit

Personal Information for 1st Partner

Personal Information for 2nd Partner

Personal Information for 3rd Partner (if applicable)

Provide a brief description of the Collaboration idea.

Number of partners