Artist Information Form 

NOTE: Items marked with aMUST be completed!

	First Name:
	Last Name:
	Address:

City:

State:

ZIP:

	Email
	Home phone:
	Work Phone:

Please name your birdhouse:

Can this birdhouse be used outdoors?

Yes  No

If your birdhouse is designed for a particular bird, name the bird:

Provide a brief description of your birdhouse:

What is your current profession?

What motivated you to build a birdhouse?

How did you become interested in your craft?

	Please describe any (a) awards you've received, (b) where your work has been exhibited, (c) where people can see your work: