Participant’s Name _________________

Age (optional) _________________

Address (optional)

__________________________________

__________________________________

__________________________________

Country of Origin____________

Date_________________

Place_________________

I, _________________(printed name of participant), hereby give full rights for the use of my digital image, recorded voice, and written text (below) for the purpose of creating printed street signs and recorded audio by the artist, Allison Hunter. I understand she will use my image as well as my written and spoken interpretation of Hobo symbology in her artwork. The resulting sign may be permanently installed in [ name of site], and may be reproduced in future exhibits of the artist’s choice. In addition, my image and interpretation of the Hobo symbol I choose (which will appear over the image of my face) may result in its reproduction for the purpose of documentation or representation of her work as an artist.

_________________(signature of participant) _________________(date)

1. Please circle a shape. This will determine the street sign to be used for your image.

HEXAGON TRIANGLE

2. Please circle a color to be used for your image.

YELLOW BLUE RED GREEN PURPLE ORANGE

3. Please circle a color to be used for your Hobo symbol.

YELLOW BLUE RED GREEN PURPLE ORANGE

BLACK WHITE

4. Choice of Hobo symbol from the provided sheet. (simple drawing)

5. Participant’s interpretation of symbol (one sentence or less).

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