Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Website Address Facebook Twitter Instagram Have you donated to Wine+Art before?*YESNOHow did you hear about Wine+Art?* KPCC LA Magazine Word of Mouth Newsletter Twitter Instagram Facebook Other If other, please describe Proceeds from art to be allocated as follows:* 100% donation to CASA/LA (includes 2 complimentary tickets to the event) 60% CASA/40% ARTIST Split* (includes 1 complimentary ticket to the event) CASA Youth only 50/50 Split *Art that is not donated by the original artist will be at 100% donation. Original artists have the option to select 100% donation or 60/40 split. CASA/LA is only accepting a limited number of pieces at 60/40 split.Artwork information as it will appear in promotional materialsName of Artist/Donor (as it will appear in promotions)* Style* Examples: abstract, symbolism, contemporary, fine art, realism, etc.Medium* Dimensions* Please separate multiple entries with a comma and in the same order as aboveRetail Value* Please separate multiple entries with a comma and in the same order as above.Detailed Description of Submission(s) for Public Viewing*Please be specific, this will accompany the artwork’s listing. If multiple pieces have been submitted: please provide a description for each piece; and if more than one proceed option was selected above, please specify and note accordingly. Please upload images of the pieces you would like us to consider. If opting for the 60% CASA/40% ARTIST split, please submit 2 images of each piece from different perspectives. All submissions will be reviewed by the auction curating committee. You will be notified within 15 business days of submission.* Drop files here or Select files Max. file size: 49 GB. *All donated art will be offered in a silent auction culminating at the Wine+Art event in November 2021. CASA/LA sets opening bids at their discretion and the opening bid is an industry standard percentage of the donor’s declared retail value of the piece. No reserves accepted. No guarantee on final sale price. All donors will be listed in promotional material (printed and digital) and are asked to cross-promote the event to their supporters. Artwork is to be delivered to CASA/LA offices no later than October 22, 2021 and if work is unsold, the artist must collect it within 30 days after the event.Signature*Date MM slash DD slash YYYY
