Memorial Medical Clinic Colchester Artwork Donation Form

Memorial Medical Clinic Colchester Artwork Donation Form
Memorial Medical Clinic Colchester is seeking local artists to donate work to create a beautiful space for patients & staff!

We are seeking art that honors our Rural community!

Donations are due by August 20

Donations can be turned in to the Colchester Clinic any time or to Steph Zimmerman Photography on August 20 from 1:00-2:00 pm - at 915 Macomb St., Colchester, IL. Series pieces are welcome. Art pieces may be turned in at a later date, please contact us to coordinate.

Please complete the form below to submit.
Artist Name*

First NameLast Name
Artist Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Artist Email Address*
example@example.com
Artist Phone Number*
Please enter a valid phone number.
Artwork Donation Item*
Medium/Donation Description
What size is the art piece?*
Please describe item (example... photo of old barn)*
DISCLAIMER: Artwork contributions must adhere to family-friendly standards, and we retain the authority to decline any submission at our discretion.
Should be Empty: