2021 ACP Fine Art Auction Please complete this form before Aug. 15. Thank you! Donor InformationDonated By:* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Website Email* Phone*Artist InfoArtist's Name* Artist's Date of Birth Artist's Birth City Artist's Current City* Photograph InfoDigital File (JPG)Please submit a large jpg (larger than 2MB, less than 20MB) or email the file with artist's CV and/or resume to email@example.com.Accepted file types: jpg, jpeg, png, gif.FileTitleDate of Photograph* Medium* Print Size Height (in Inches)* Print Size Width (in inches)* Framed Height (in Inches)(if applicable - if not, leave blank.) Framed Width (in inches)(if applicable - if not, leave blank.) Framing specifications(if applicable - if not, leave blank.) Edition number*(if applicable - if not, put N/A) Artist Proof? Yes No Signed?* Yes (on verso - back) Yes (on recto - front) No Value (current retail)*Paragraph about this image (or series)Include here or email separately to firstname.lastname@example.org (250 words, max)Abbreviated Artist BioInclude here or email separately to email@example.com (250 words, max)Donation Amount* I wish to donate this item/lot 100% to ACP, a 501(c)3 non-profit I wish to donate 75% of this item/lot to ACP (Donor listed above will receive a check for 25% of the proceeds) I wish to donate 60% of this item/lot to ACP (Donor listed above will receive a check for 40% of the proceeds) Deadline to ship artwork is August 15, 2021*I'll ship artwork to: Atlanta Celebrates Photography 1038 Grant St. SE #A24-105 Atlanta, GA 30315 or I will arrange delivery/pick-up locally. The UPS act# for ACP is #2W3107. For shipping via other carriers, ACP will reimburse me as soon as they have my receipt. I understand that inadequately packaged artwork will likely get damaged. Therefore I will make sure my items are packaged extremely well, and items require a signature upon delivery. Yes, I have read and agree with the shipping info.