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Mirrors 5 Registration Form

Los Angeles County Psychological Association

Mirrors of the Mind 5: Psychotherapist as Artist

Visual Arts Registration Form

Instructions: Cut and paste information below into a separate word document.

Do not include extended instructions in the final form.




Degree or Student Status (as would appear on your artist statement):



Contact email:


Contact phone:

Website (if relevant to art):

Visual Art Description

You may enter up to 3 entries per medium (e.g., painting, photography, drawing, sculpture, print-making, video loop). In the space below, please list the title of each piece (or Untitled), medium used, and dimensions. Send all corresponding JPGs by email to mirrorsofthemind2016@hotmail.com. 


Make sure the title of each JPG file matches the title of each piece as listed below.

If possible, send high resolution images (2550 x 3300 pixels, equivalent to 8.5 x 11 inches at 300 dots per inch). That way, if your piece(s) is selected for the show and LACPA publishes an art exhibition catalogue; your image will be up to book publication standards.


Title of Each Piece:


Medium used:


Dimensions of each piece:


Artist Statements

In a separate file, your artist statement should be no more than 350 words in length single space in Ariel font size 12. The focus should be on the psychological significance and meaning of your art. We invite you to include thoughts on the role of creativity in your professional development and well being. If you have multiple entries, include a few sentences specific to each entry. Please include the medium used and size of each piece in the artist statement. Also include contact information and/or a link to your website.

Submit all forms and fees (see Prospectus) no later than August 22, 2016

Email Registration Form, Artist Statement, and Art Images to: mirrorsofthemind2016@hotmail.com

For questions about the art exhibition, contact

Terry Marks-Tarlow, PhD at markstarlow@hotmail.com or (310) 458-3418

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