PERMISSION / AUTHORIZATION
TO PRINT ARTISAN INFORMATION
ON CACE WEBSITE

Print form, complete and mail to CACE, P.O. Box 244, Crossville TN 38557.

INDIVIDUAL LISTING Please print carefully.

1. Name: ______________________________________________________
   
   Mailing Address:
   Number/Street/P.O. Box _______________________________________
   
   City/State/Zip__________________________________________________
   
   Email:________________________________________________________
   
   Telephone:____________________________________________________
   
   Website: _____________________________________________________
   
   Select one of the following: ____Written ____Performing ____Visual (2-D, 3-D)
   
   Medium Description: ____________________________________________________________________
   

I hereby give CACE permission to print the above information on the CACE web site and certify that I live in Cumberland County, Tennessee.

Signed: ____________________________________ Date _________