First Name * Last Name * Address * City * State * Zipcode * Email Address * Website Telephone * Cell Phone Affiliation with Yale * Alumnus Faculty Spouse or immediate family member Staff Student Yale Health member Piece 1 Title of piece 1 * Medium of piece 1 * Size of piece 1 * Price of piece 1 * Year piece 1 completed * Upload image 1 * Suggested upload is a file that is 1500 pixels wide or in the longest dimension at a resolution of 72 and a colorspace of sRGB.Files must be less than 5 MB.Allowed file types: gif jpg jpeg png. Piece 2 Title of piece 2 * Medium of piece 2 * Size of piece 2 * Price of piece 2 * Year piece 2 completed * Upload image 2 * Suggested upload is a file that is 1500 pixels wide or in the longest dimension at a resolution of 72 and a colorspace of sRGB.Files must be less than 5 MB.Allowed file types: gif jpg jpeg png. Piece 3 Title of piece 3 * Medium of piece 3 * Size of piece 3 * Price of piece 3 * Year piece 3 completed * Upload image 3 * Suggested upload is a file that is 1500 pixels wide or in the longest dimension at a resolution of 72 and a colorspace of sRGB.Files must be less than 5 MB.Allowed file types: gif jpg jpeg png. Piece 4 Title of piece 4 * Medium of piece 4 * Size of piece 4 * Price of piece 4 * Year piece 4 completed * Upload image 4 * Suggested upload is a file that is 1500 pixels wide or in the longest dimension at a resolution of 72 and a colorspace of sRGB.Files must be less than 5 MB.Allowed file types: gif jpg jpeg png. Piece 5 Title of piece 5 * Medium of piece 5 * Size of piece 5 * Price of piece 5 * Year piece 5 completed * Upload image 5 * Suggested upload is a file that is 1500 pixels wide or in the longest dimension at a resolution of 72 and a colorspace of sRGB.Files must be less than 5 MB.Allowed file types: gif jpg jpeg png. Piece 6 Title of piece 6 * Medium of piece 6 * Size of piece 6 * Price of piece 6 * Year piece 6 completed * Upload image 6 * Suggested upload is a file that is 1500 pixels wide or in the longest dimension at a resolution of 72 and a colorspace of sRGB.Files must be less than 5 MB.Allowed file types: gif jpg jpeg png. Piece 7 Title of piece 7 * Medium of piece 7 * Size of piece 7 * Price of piece 7 * Year piece 7 completed * Upload image 7 * Suggested upload is a file that is 1500 pixels wide or in the longest dimension at a resolution of 72 and a colorspace of sRGB.Files must be less than 5 MB.Allowed file types: gif jpg jpeg png. Piece 8 Title of piece 8 * Medium of piece 8 * Size of piece 8 * Price of piece 8 * Year piece 8 completed * Upload image 8 * Suggested upload is a file that is 1500 pixels wide or in the longest dimension at a resolution of 72 and a colorspace of sRGB.Files must be less than 5 MB.Allowed file types: gif jpg jpeg png. Piece 9 Title of piece 9 Medium of piece 9 Size of piece 9 Price of piece 9 Year piece 9 completed Upload image 9 Suggested upload is a file that is 1500 pixels wide or in the longest dimension at a resolution of 72 and a colorspace of sRGB.Files must be less than 5 MB.Allowed file types: gif jpg jpeg png. Piece 10 Title of piece 10 Medium of piece 10 Size of piece 10 Price of piece 10 Year piece 10 completed Upload image 10 Suggested upload is a file that is 1500 pixels wide or in the longest dimension at a resolution of 72 and a colorspace of sRGB.Files must be less than 5 MB.Allowed file types: gif jpg jpeg png. Your signature Signature By my electronic signature below I confirm that I have read the Guidelines for The Arts at Yale Health and agree to all of the terms and conditions therein. Sign with your mouse or pen (tablet). Signer Name * Signer Title * CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
