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BRANCHES ENTRY FORM
(One entry form must accompany each submission.)
Contributor's Name
Complete Address
Phone Number
E-mail address
Alternate E-mail Address
Title of Work:
Check appropriate box:
Prose
Poetry
2-D Art 3-D Art
Medium(s): _
I grant CCC&TI permission to publish my work in Branches and on line. I give Caldwell
Community College and Technical Institute the rights to reproduce my accepted artwork for
purposes of display, promotion and fundraising.
(Signature)
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