Entry Form — Marlborough Art Society

Title of Exhibition:

Name

First Name

Last Name

Email

Phone Number

Bank Account No

GST Registered

Yes

No

Title of Work 1

Medium

E.g. Oil on canvas, watercolour, pencil, mixed media etc

Size

Price

$

Title of Work 2

Medium

E.g. Oil on canvas, watercolour, pencil, mixed media etc

Size

Price

Enter 1 if only exhibiting 1 artwork

$

Supervising at Gallery

Please state your preferred day, date and either morning (10.30am to 1.30pm) or afternoon session (1.30pm to 4.30pm)

If unable to collect my art at conclusion I have arranged for the following person to collect on my behalf

Please advise name, phone number and/or email address

Signature and Date

I understand and agree to the Conditions of Entry for Exhibition as explained on Conditions of Entry page