*
E-mail:*
Surname:*
Given Name:*
Address:*
Phone:
-
ABN (if applicable):

EXHIBIT DETAILS

Name 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:

FORWARDING DETAILS

Courier/Company:
Depot:
Return of Exhibit:*
Forwarding instructions:

ACCEPTANCE OF EXHIBITION CONDITIONS

I 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 633000
Acct No.:  111791232
Acct 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:

Important:  If you do not receive a confirming email within 24 hours, contact 0419504539

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