*Name:
Address:
City:
State/Country:
Zip/Postal:
Phone:
*Email:
Please add me to your mailing list:	yes     no
I am an artist:	yes     no
I am a patron or art buyer:	yes     no
I have been to Core's openings:	yes     no
I am interested in renting gallery space:	yes     no
I am interested in membership:	yes     no
Please add any comments or questions you might have: