participate in North Van City Mosaic

Thank you for participating in the North Van City Mosaic, you rock!

Please fill out this form.

First name (or initial or “anonymous”) *

Last name (or initial or “anonymous”)

Age

Email (Your email will stay private and we won't share it with any third party. We need it to contact you to let you know if your participation is used in a public art project for example) *

Write a short text to let others know what your image is about. (1000 words maximum/ optional )

Upload picture (JPEG only minimum 1024 x 1024 px). *

By checking “Yes”, I give permission to “North Van City Mosaic, Collective Art project” to use
and modify the image and comments (the “Content”) I am sending in the collective art work.
I am giving the right to display, use, publish the Content for commercial or exhibition purposes. I also consent to the Content being included as part of “North Van City Mosaic” digital or printed Artwork.

Permission *

Yes

North Van City Mosaic, participation form