ARTS DIRECTORY APPLICATION

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* 1. Choose one option below:

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* 2. Contact Information:

Name *

Company

Address *

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 3. Website URL (if applicable):

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* 4. Facebook URL (if applicable)

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* 5. Instagram URL (if applicable):

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* 6. Please provide a short biography in the third person or a short description of your arts organization/business (300 words or less):

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* 7. Artwork medium OR Arts Service:

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* 8. Please upload or email an image you would like displayed as your feature image for the City website:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 9. Please upload a logo image if you are an arts organization or business:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 10. Please acknowledge the statements below by clicking each box and signing and dating below:

I give permission to include my name, social media information, biography and images of my artwork in the City of Costa Mesa’s Arts Directory on the City’s website.

Waiver & Release: I certify that the information contained in this application and attachments are true and correct.

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* 11. I represent that I am the author of and owner of all rights in and to the Artwork and or "Featured Image" and that I have the sole and exclusive right to make within the grant of rights, including but not limited to moral rights, that neither I nor anyone else has any contractual or other arrangements which will interfere with rights herein granted and warrant that the rights herein granted will not infringe on the rights of any third party and that the consent or permission of no other party is required by City in connection with the use of the Artwork. I agree to indemnify and hold City harmless from and against any and all liability, damages, claims and demands of whatever kind and nature, either in law or in equity, which arises or may hereafter arise from the City's use or display of the Artwork or in connection with the breach or alleged breach of my representation and/or warranty made hereunder.

I agree to the above statement by signing/typing my name:

Date: