Host certificate

This host certificate helps me keep track of the artwork, and help the art-piece complete it self, as part of the piece is online on my website and social media.

Please add a picture of the adopted immigrant to instagram and mark it with this hashtag #55immigrants @david_ramirez_gomez_

ALL YOUR PRIVATE INFORMATION IS ONLY FOR PERSONAL USE, JUST THE NAME OF THE CITY WERE THE PIECES ARE HOSTED WILL BE POSTED ONLINE.

Name

First Name

Last Name

Email Address

Address of the artwork 55 immigrants

All blanks must be filled-out

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Optional message

Thank you for participating

David Ramirez Gomez and Galerie 55Bellechasse.