Please legibly write or type the following information on a sheet of paper:

1. YOUR NAME:
2. ADDRESS:
3. E-MAIL:
4. NUMBER OF PRINTS:
5. CONTRIBUTION AMOUNT:

For a minimum contribution of $30 one print will be sent to you, signed by the artist. Please specify how many prints you would like and contribute accordingly. If you do not wish to receive a print, but still want to make a contribution, please indicate that clearly. Contributions in any amount are accepted.