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Mirrors 6 Entry Fee Form

 

Mirrors of the Mind 6: The Psychotherapist as Artist

VISUAL ARTS ENTRY FEE GUIDELINES

 

FEES MUST BE RECEIVED BY September 21, 2017:  You may submit up to 3 pieces of art per medium (e.g., water colors; oil paints; sculpture; drawings; photography). There is a single, nonrefundable $25 artist submission fee (no matter how many pieces you submit) for Los Angeles County Psychological Association (LACPA) members, a $35 fee for non-LACPA members, and a $20 fee for psychotherapy students.

 

Name ___________________________________________   Degree _______________

 

Address________________________________________________________________

 

City/Zip ________________________________________________________________

 

Phone Number ___________________________________________________________

 

Email Address ___________________________________________________________

 

TO PAY ONLINE:  CLICK HERE  

 

TO DOWNLOAD FORM:  CLICK HERE

 

TO PAY BY MAIL: MAKE CHECK PAYABLE TO LACPA

WRITE: Mirrors of the Mind 6 in the memo line.

 

MAIL CHECK OR CREDIT CARD INFO TO:

LACPA, 6345 Balboa Blvd., Suite 126, Encino, CA 91316                                                                                 

 

Your check or credit card information must be received by September 21, 2017, in order to qualify for exhibition submission. In situations where the artist submission fee is a financial hardship, contact

Dr. Pamela McCrory by email: mccroryphd@earthlink.net.

 

 

TO PAY WITH CREDIT CARD COMPLETE AND MAIL INFORMATION BELOW:

 

AMOUNT TO BE CHARGED _________________________

 

VISA OR MASTERCARD NO. ___________________________________________________

EXPIRATION DATE____________    THREE SECURITY NUMBERS ON BACK OF CARD ____________


NAME ON CREDIT CARD ______________________________________________________


BILLING ADDRESS FOR THIS CREDIT CARD

STREET____________________________________________________________________

 

CITY___________________________________ AND ZIP CODE_______________________


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