You must have a conference registration number first in order to register for Critiques by NIADA artists. Please print all information: Conference Registration # ___________________________ NAME _________________________________________________________ ADDRESS _____________________________________________________ ________________________________________________________________ PHONE _____________________________________ EMAIL ADDRESS ______________________________________________ Number of Critiques requested: ______________ My medium is: __________________________________ My areas of interest/problems are: ________________________________________________________________________ ________________________________________________________________________ I would like to request the following specific artist(s) ________________________________________________________________________ *REQUESTS WILL BE HONORED IF POSSIBLE. IF NOT, NIADA WILL TRY TO ASSIGN AN ARTIST WORKING IN A SIMILAR DISCIPLINE. Critique fee: $25 each. Amount enclosed___________________________ PAYMENT INFO: _____ CHECK (payable to NIADA, Inc.) _____ PAYPAL _________________email account associated with Paypal _____ CREDIT CARD ___VISA ___MASTERCARD CARD NUMBER _____________________ EXP. DATE ______ NAME AS IT APPEARS ON CARD ____________________________ SIGNATURE______________________________________________ Print and mail form with payment to: Diane Keeler, Critique Chair
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