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Port Pirie Art Prize 2009 ENTRY FORM Refer to Information flyer by lindayy

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Port Pirie Art Prize 2009 ENTRY FORM Refer to Information flyer ...

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									Port Pirie Art Prize 2009
ENTRY FORM Refer to Information flyer for Conditions of Entry
Port Pirie Art Prize Exhibition dates: 5 September to 11 October 2009
Closing date for entry: Entry form must be received by Friday 7 August 2009.
Delivery dates: Works must be delivered to Port Pirie Regional Art Gallery (3 Mary Elie Street, Port Pirie)
between 21 and 28 August 2009. No work will be accepted after 28 August.


Name of artist:_______________________________________________________________________________
Address:_____________________________________________________________________________________
Contact phone numbers - home:_________________________ mobile:______________________________
Email:_______________________________________ Date of birth: ___________________________________
Please indicate which categories you would like enter
Open prize          Southern Flinders Artist Prize              Photographic Prize            Youth Prize (17 to 25 years of age)
DETAILS OF ARTWORK
(Work must address the theme to be eligible for any prize)
Title of work:________________________________________________________________________________
Year (work must have been created during the past 12 months) _______________
Medium: ______________________________Size: (height by width in cms) _____________________________
Artwork is framed / stretched ready for exhibition (with ‘D’ rings attached for hanging):                                             YES
Retail price: $________________
Artist statement (what the work is about): Please write on back of this entry form
(Statement submitted with this entry form may be displayed with your artwork - attach extra sheet if needed)
I will be attending the opening                                                                                          Yes           No


DECLARATION (Please tick):
           I have read and accepted the Conditions of Entry
           I am the creator of this original artwork.
           I have attached the cut-off section below to my artwork.
           I give permission for my artwork to be reproduced during the exhibition for promotional purposes only.
           This artwork is for sale.
           I have enclosed an entry fee of $10 per work
           I will arrange delivery of my artwork to Port Pirie Regional Art Gallery, and be responsible for collection of
           artwork within seven (7) days of completion of exhibition
Signed: _____________________________________________
Date: _______________________________________________
-------------   ------------------------------------------------------------------------------------------------------------------------------------
Please attach this section to the top right back corner of your entry
Artist name:___________________________________________________________________________________
Address:______________________________________________________________________________________
Phone:______________________________________Mobile:____________________________________________
Title of entry:__________________________________________________________________________________
Medium:______________________________________________________________________________________
Retail price:____________________________


Port Pirie Art Prize 2009                                          1                                                           Application form

								
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