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Artist: ______________________________________

Mailing Address: ______________________________

____________________________________________

Telephone: __________________________________

e-mail address: _______________________________

I hereby release the city of Kenai, Peninsula Art Guild, Kenai River Council on the Arts, its employees and or agents, for any damage, loss, theft, destruction or diminution in value of any personal property that I have displayed, by or through Kenai Fine Arts Center.

I have read the above release, understand and agree to the terms.

Signed ________________________________ Dated _____________________

Item #   Title/Description             Price Received   Sold/Removed     Receipt #