Quilt Registration Form

Category: (Note: Large is more than 240 inches perimeter in size.)

CHOOSE ONE Large Applique Large Pieced Small Applique Small Pieced Mixed Technique Two Person Quilt Group Quilt Wearable Art Kids-Novice (Non-Ribbon Category) Treasured Quilts (Non-Ribbon Category) Quilts That Nearly Drove Me Insane (Non-Ribbon Category)

Entrant First Name:

Entrant Last Name:

Entrant Street Address:

Entrant City:

Entrant State:

Entrant Zip Code:

Daytime Phone (678-222-1234 format):

Evening Phone (678-222-1234 format):

Entrant Email Address:

Are you a member of Chattahoochee Evening Stars?

Yes No

Title of Entry:

Date Quilt Completed (MM/DD/YY):

(Remember, it must be completed between dates of 6/12/04 and 6/10/06.)

Quilt Width in Inches:

Quilt Length in Inches:

Piecing Technique:

CHOOSE ONE Machine Piecing Hand Piecing Not Applicable

Pieced by whom (e.g., Entrant, Sue Jones, N/A):

Appliqué Technique:

CHOOSE ONE Machine Applique Hand Applique Not Applicable

Appliquéd by whom (e.g., Entrant, Sue Jones, N/A):

Quilting Technique:

CHOOSE ONE Machine Quilting Hand Quilting

Quilted by whom (e.g., Entrant, Sue Jones):

If Other Technique was used, describe in the paragraph below. Otherwise, leave this paragraph blank:

Choose the correct Design Type/Pattern Source for this quilt:

CHOOSE ONE Original Design Adaptation of a Pattern Workshop Other Artwork

If this quilt was an Adaptation of a Pattern, identify the designer or source. Otherwise leave blank:

If this quilt was from a Workshop, identify the instructor. Otherwise leave blank:

If this quilt pattern source was from a book, provide the title, author/publisher information. Otherwise, leave blank:

If you selected Other Artwork, provide the details below. Otherwise, leave blank:

Choose your Quilt Delivery Method:

CHOOSE ONE I will Hand Deliver This Quilt to the Show I will Ship This Quilt to the Show

CES requests the right to use a photo of your quilt in any publication, advertisements, and any printed/electronic materials. Please indicate your response to this request below:

CHOOSE ONE CES is granted permission No, permission is NOT granted

Quilt Insurance is available for the CES Show through NQA. Do you wish to purchase Quilt Insurance for the Show?

Yes No

Please indicate the approximate dollar value of your quilt (regardless of if you are insuring it or not):

$

Quilt Insurance is priced at $4.20 per $1000 of coverage. Minimum coverage rate if $4.20. If you indicated you will insure your quilt, indicate the amount you will be purchasing.

CHOOSE ONE $4.20 for $1000 coverage $8.40 for $2000 coverage $12.60 for $3000 coverage I am NOT planning to insure my quilt through NQA for the Show

Please use this space to write a description of your item (up to 75 words). Include anything you want the viewers to know. For example, who the quilt was made for, inspired by, how long it took to make, etc. Please include any special techniques used in its making: