SW2011form


	SMALL WORKS $10,000 Prize 2011 Please fill out the form below and make your payment via the options indicated. To ensure we get your entry please email sw2011@bsgart.com.au asking for a confirmation of your entry. Ensure your images are less than 200k.

Name:
Email Address:
Street:
Suburb:
Post Code:
Phone:
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: (Ensure images are less than 200k)
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2nd Work Image:
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3rd Work Image:
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4th Work Image:
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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