Send to myself* E-mail:*Surname:*Given Name:*Address:* Street AddressCityState / Province / RegionPostal / Zip CodePhone: Area Code - Phone Number ABN (if applicable):EXHIBIT DETAILSName of Work:*Medium:*Selling Price:*AWARDS: All exhibits are automatically eligible for Awards 1, 9 and 10. You may elect to enter your artwork for any of the awards below provided that your entry meets the medium/subject or residential criteria for the award (see Conditions of Entry). All these awards are acquisitive.Additional Awards:2345678FORWARDING DETAILSCourier/Company:Depot:Return of Exhibit:*Collection by HandCollection by Courier (see below)Forwarding instructions:ACCEPTANCE OF EXHIBITION CONDITIONSI have read and accept the conditions of entry and sale. I understand and accept that neither BCAG Inc nor Burnie City Council will be responsible for any loss or damage whatsoever and however caused to any work while in their custody. I understand that I am responsible for insuring my entry. By toggling the field below, I legally accept the exhibition conditions of entry and sale.I Accept*PAYMENT: Payment may be by hand, cheque through the post or by Direct Debit. Details for Direct Debit are:Bendigo Bank BSB 633000Acct No.: 111791232Acct Name: Burnie Coastal Art Group.If you choose to pay by Direct Debit, please put your surname in the Transaction/Customer Identification field when making payment. For ease of tracing payments, please record the Transaction/Customer Identification in the field below.Transaction/Customer Identification:Word Verification:SubmitResetImportant: If you do not receive a confirming email within 24 hours, contact 0419504539