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 Single image submission Title of piece * Medium of piece * Size of piece * Price of piece * Year piece completed * Upload image * 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.
