Ship Store Galleries
Fine Art & Antiques - Est. 1978
_________________________________________________________________
4-484 Kuhio Highway, P. O. Box 1058, Kapaa, Hawaii 96746
Office: (808) 822-4999 - Fax: (808) 822-2506 - Phone Orders: 1-800-877-1948

C A R O L I N E    R .   Y O U N G    B O O K     R E L E A S E     A U T H O R I Z A T I O N

I/We, ............................................................................., hereby authorize Caroline R. Young
to use my/our name(s) in her upcoming book "The Art of Caroline R. Young."

To be listed in the book, please provide the following information:

...................................................................................................................
[name(s) as it should be listed - please print]

ex. John Smith
John & Mary Smith
Mr & Mrs John Smith
John Smith
Mary Smith

Signature:...................................................................................................

Date:..........................................................................................................

Telephone:.................................................................................................

E-mail:.......................................................................................................