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Mirrors Entry Fee Form

 

Mirrors of the Mind 8: The Psychotherapist as Artist

VISUAL ARTS ENTRY FEE GUIDELINES

 

FEES MUST BE RECEIVED BY September 3, 2019:  You may submit up to 3 pieces of art per medium (e.g., watercolor; oil paint; sculpture; drawings; photography). There is a nonrefundable, $25 artist submission fee per piece for Los Angeles County Psychological Association (LACPA) members, a $35 fee per piece for non-LACPA members, and a $20 fee per piece for psychotherapy students.

 

Name: ___________________________________________   Degree: _______________

 

Address: ________________________________________________________________

 

City/Zip: ________________________________________________________________

 

Phone Number: ___________________________________________________________

 

Email Address: ___________________________________________________________

 

TO PAY ONLINE:  CLICK HERE

When registering online:

For one item you will need to check item one only.

For two items you will need to check item one and the second item. 

For three items you will need to check item one, the second item, and the third item. 

If you have more than 3 items, contact the LACPA Office at 818-905-0410.

 

TO PAY BY MAIL: MAKE CHECK PAYABLE TO LACPA

WRITE: Mirrors of the Mind 8 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 3, 2019 in order to qualify for exhibition submission. If the artist submission fee is a financial hardship, please contact Dr. Pamela McCrory by email: mccroryphd@earthlink.net.

 

 

TO PAY WITH CREDIT CARD COMPLETE AND MAIL INFORMATION BELOW:

 

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___________________________________ ZIP CODE______________

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