Illustration of a service dog drawing with a paintbrush, accompanied by the text "Art Unleashed Service Dogs of Virginia."

Art Unleashed Artist Application

Name

First Name

Last Name

Company (if applicable)

Phone

(###)

###

####

Exact name to be on the plaque, used in advertising, etc.

Address

City, state, zip

Website

Assurances: I have completely read the Artist’s Prospectus, including the Copyright Assignment, all Tips and Techniques, and agree to its contents in full. I acknowledge that all application materials will become the property of Service Dogs of Virginia and no materials will be returned to the artist. I certify that I am at least 18 years of age.

I Agree

(Optional) I have my own sponsor who is interested in sponsoring my statue. (Submission of the required agreement from the sponsor packet, which can be found on our website, is required.)

Yes

Sponsor's name

Sponsor's phone number

Sponsor's email

Use the boxes below to tell us about 1 or 2 proposed design ideas.

Suggested title for your first design

Suggested title for your second design

service dogs of virginia

Mailing Address: P.O. Box 408
Charlottesville, VA 22902

Physical Address: 673 Berkmar Ct.
Charlottesville, VA 22901

(434) 295-9503
info@servicedogsva.org