Artist/Donor Name *

First Name

Last Name

Artist/Donor Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Artist/Donor Phone *

(###)

###

####

Delivery Method *

I will deliver artwork to the Science Mill (101 S. Lady Bird Lane, Johnson City, TX)

Please call to arrange pick up

Donation Terms *

I would like to donate 50% of the sale price to the Science Mill

I would like to donate 100% of the sale price to the Science Mill

I consent that an image of my artwork may be used to promote Science Mill benefit fundraising event. *

Please email a photo of your artwork to jessica.gillespie@sciencemill.org

Yes

No

As a donor, you and a guest are invited to attend the event! Please provide the name of your guest to caleb.campaigne@sciencemill.org *

Yes, I will be attending the Science Mill Annual Benefit

No, I will not be able to attend the Science Mill Annual Benefit

I understand that my donated art will be for sale at the Science Mill's Benefit fundraising event. Art not sold at the event will be returned to the artist. *

Yes, I agree.

No, I do not agree.