SW2010form


	SMALL WORKS $10,000 Prize Please fill out the form below and make your payment via the options indicated.

Name:
Email Address:
Street:
Suburb:
Post Code:
How did you here about the Prize:
If other where?
How Many Entries?
Payment:
If Credit Card Name on Card:
Card Number:
Expiry Date:
1st Work Title:
1st Work Medium:
1st Work Size (cm):
1st Work Price:
1st Work Image:
2nd Work Title:
2nd Work Medium:
2nd Work Size (cm):
2nd Work Price:
2nd Work Image:
3rd Work Title:
3rd Work Medium:
3rd Work Size (cm):
3rd Work Price:
3rd Work Image:
4th Work Title:
4th Work Medium:
4th Work Size (cm):
4th Work Price:
4th Work Image:
5th Work Title:
5th Work Medium:
5th Work Size (cm):
5th Work Price:
5th Work Image:
6th Work Title:
6th Work Medium:
6th Work Size (cm):
6th Work Price:
6th Work Image:
7th Work Title:
7th Work Medium:
7th Work Size (cm):
7th Work Price:
7th Work Image:
8th Work Title:
8th Work Medium:
8th Work Size (cm):
8th Work Price:
8th Work Image:
9th Work Title:
9th Work Medium:
9th Work Size (cm):
9th Work Price:
9th Work Image:
10th Work Title:
10th Work Medium:
10th Work Size (cm):
10th Work Price:
10th Work Image:
Return of Artwork:
Bank Account (For payment if work sold - include BSB):
Biography (500 words or less):
I agree to the terms and conditions:	Agree