ARTIST / COLLECTOR
SURVEY
To add additional potter names, corrections, or further information please fill out the following information by either copying and pasting into an email or printing and mailing to:
Monica King
PMB 36
10390 S Sierrita Mtn Rd
Tucson, AZ 85736
(520) 822-1195
PLEASE SUBMIT PHOTOGRAPHS OF POTTERY INCLUDING SIGNATURE AND/OR HALLMARK. ARTISTS ARE ENCOURAGED TO INCLUDE PHOTOS OF THEMSELVES WITH THEIR WARES. If emailing please submit photos in jpeg format.
Please fill out form to best of knowledge.
Potter Name: ______________________________________________________________
Tribe/Nation/Culture: ________________________________________________________
Signature/Hallmarks: ________________________________________________________
Birthdate: ______________________ Approx. Year started making pottery: ___________
Address:___________________________________________________________________
Email: ____________________________ Phone Number: ___________________________
Father: _____________________________ Mother: _______________________________
Pottery making family members: _________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Teacher: ____________________________________________________________________
Student(s): __________________________________________________________________
Exhibitions: _________________________________________________________________
____________________________________________________________________________
Awards: ____________________________________________________________________
___________________________________________________________________________
Remarks/Comments: _________________________________________________________
___________________________________________________________________________
____________________________________________________________________________
"I, ____________________________ , give permission for any information and/or photos
submitted to be used by Dan & Monica King of rarepottery.info"
Signed: ___________________________________________ Dated:__________________
If you are a collector submitting information please provide contact information.
Revised: 03/31/2008
Copyright 2008