Entry form for exhibitors - Entries close November 8, 2019 at 7 pmPost to PO Box 238 Kinglake or email to news@kinglakeartshow.com.au

First Name Surname

Address:

City

Post Code Mobile Phone

Email

Exhibit entry details:

Ex.No. Title/Other Details Section Medium Dimensions Price

Sections (Please indicate preferred section above) Landscape (L) - Flora & Fauna (FF) - Portrait (P) - Contemporary/Abstract (CA) -

Single Media (SM) - Mixed Media (MM) - Photography (PH) - General Textiles (T) – Quilts (Q) – 3D Printing/Laser/CNC Work (3DLC) - - Primary School (PS)

Mediums – (Please indicate medium above) Watercolour, Oil, Acrylic, Pastel, Pen & Wash, Charcoal, Gouache, Ink, Mixed, Woodwork, Metalwork, Textiles etc (Please describe)All items entered must be available for sale during the Art show. All items must be ready for display, if there is no wire to enable hanging, the work may not be displayed. Please ensure the name of artist, title, medium and selling price is attached to the back of 2D work or by tag in other categories.If you wish to have a printed description alongside each work, please submit no more than 100 words per item.

Each exhibitor is entitled to two discount Opening Night Tickets at $5 Number of discount Opening night tickets @ $5 each …………………. $......................Number of general Opening night tickets @ $10 each …………………. $......................Entry Fees $8 per item for Ranges Residents - $12 per item for non-residents.Method of delivery: (please mark one with an X)

Personal Delivery Other (e.g. other Artist/agent - please specify _____________________________________

Method of Collection (please mark one with an X Personal Collection Other (e.g. other Artist/agent - please specify _____________________________________

My Bank account details for payment of any sales less commission

Name________________________________________________ BSB ______________________ Account No___________________

Enclosed: Entry fees $___________ Opening Night tickets $___________ TOTAL $___________________

Paid by Cheque ________________Money Order ________________ Cash __________________

Direct Deposit to Kinglake Ranges Art Show - BSB: 633 000 Account Number 161241427Please ensure your name and the word “Exhibits” is on the deposit as a reference

Charge my credit card Visa_____Mastercard _____ Name _____________________________________________

No. _______________________________________________________________________Expiry_____/_____ CVC_______

Signed _______________________________________________________________________Date: __________________________________2019

If you know any other artist who might like to receive an entry form please include their details below.

Name:

Email:

Artist’s Declaration/Release & Indemnity

I acknowledge that I have read and understood both the conditions of entry and the Release and Indemnity form. I also note The Rotary Club of Kinglake Ranges is a service club and general fundraiser for charities and does not submit GST returns. The Club will provide a cheque or direct deposit to my nominated bank account for 80% of the nominated selling price for all works sold.

Please Note: Any Invoice, record or GST payment return is entirely the responsibility of the Artist.This should be taken into consideration when setting selling price.

Signed _______________________________________________________________________Date: __________________________________2019