Georgies Ceramic And Clay Co. Portland / Eugene Gallery Submission Form ========================================================= Please fill out and include 4 JPG pictures of your work Email JPG to gallery@georgies.com (*) required fields Date: [___________________________] Name:(*) [______________________________________________________] Address: [______________________________________________________] City St Zipcode: [______________________________________________________] Email Address: (*) [_____________________________________________________] Telephone: (*) [______________________________________________________] Description of Work: (Note Which Georgies Clay and Glazes Used) [______________________________________________________] [______________________________________________________] [______________________________________________________] [______________________________________________________] [______________________________________________________] [______________________________________________________] [______________________________________________________] [______________________________________________________] [______________________________________________________] [______________________________________________________] [______________________________________________________]