WOP12form


	Works on Paper 2012 $10,000 Prize and Exhibition Please fill out the form below and make your payment via the options indicated. If you have trouble with the form or do not get a confirmation email for your entry please email your details, images of your entres and details including title, medium, size and price together with your method of payment and we will confirm your entry. As a safeguard please email mark@bsgart.com.au that you have entered so we can check we have received your entry.

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)
2nd Work Title:
2nd Work Medium:
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2nd Work Price:
2nd Work Image:
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10th Work Title:
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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