Form Center

2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Email Address*
14. Phone Number*
15. Date*
    Date
19. Artist Bio*

    Artist Bio should not exceed 100 words.

25. Title of Artwork*
27. Description*

    Brief description of the artwork - description should not exceed 100 words.

29. Medium*

    Oil on canvas, digital illustration, etc.

30. Date of Creation*
    Date of Creation

34. I, the undersigned, the creator and sole owner of the aforementioned artwork, hereby grant permission to the City of Russellville and Russellville Advertising & Promotion Commission to reproduce, display, and otherwise utilize the artwork for the following purposes:

    • Display in public spaces within the City of Russellville.
    • Inclusion in promotional materials related to Russellville events and programs.
    • Any other purposes deemed appropriate by the City of Russellville and Russellville Advertising & Promotion Commission that are consistent with promoting and advertising.

    This release is granted without any financial compensation, and the City of Russellville and Russellville Advertising & Promotion Commission is hereby granted a non-exclusive, perpetual license to use the artwork for the specified purposes outlined above.

    I retain all copyright and intellectual property rights to the artwork, and this release does not transfer ownership of these rights to the City of Russellville, Russellville Advertising & Promotion Commission or any other party.

    I understand that the City of Russellville and Russellville Advertising & Promoting Commission will make reasonable efforts to credit me as the artist whenever the artwork is used, whenever feasible.

36. Signature*

    Please type your name.

37. Date*
    Date
39. Art Piece 1*
40. Art Piece 2
41. Art Piece 3
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field