Name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

For a 3D artwork, is a plinth required?

Yes

No

$50 entry fee payment *

Bank Deposit; BSB: 633 000 - Acc# 111 791 232 Reference is Tasart last name and initial/s (preferred method)

Cash on delivery

Burnie City Council Award: Do you wish to be to be considered for that award only? *

Yes

No

Ruth Forest Award. Do you wish to be considered for that award? *

Yes

No

Waratah/Wynyard Award; Are you a resident of the Waratah/Wynyard Municipality and wish to be considered for that award?

Yes

No

Cradle Coast Award; Are you a resident of the Cradle Coast and wish to be considered for that award?

Yes

No

Emerging Artist Award; if you have not received an award previously do you wish to be considered for that award?

Yes

No

Members Award; Are you a member of BCAG and wish to be considered for that award?

Yes

No

Conditions of entry *

I have read and accepted the conditions of entry for this competition. I certify that the work entered into this competition is my original artwork, and has been completed in the 12 months preceding the closing date for this competition.

Accept and certify