First Name (required)
Surname (required)
Address 1 (required)
Address 2
Town / City (required)
Post Code (required)
Contact Phone (required)
Email (required)
Young Artist Award — Date of Birth
Only provide this if you want to be considered for the Young Artist Award.
Bank Account (required)
Artwork 1
Category (required)Select a categoryCategory 1 - Painting / 2D MediaCategory 2 - Printmaking / Photography / Digital GraphicsCategory 3 - 3D Media / Sculpture / JewelleryCategory 4 - Textile / Embroidery / Stitch
Title (required)
Medium (required)Select a mediumOil PaintingAcrylic PaintingWatercolour PaintingMixed Media2D dimensional mediaPrintmakingPhotographyDigital graphics3D mediaSculptureJewelleryTextileEmbroideryStitch
Price (required)$
Artwork 2 (optional)
CategorySelect a categoryCategory 1 - Painting / 2D MediaCategory 2 - Printmaking / Photography / Digital GraphicsCategory 3 - 3D Media / Sculpture / JewelleryCategory 4 - Textile / Embroidery / Stitch
Title
MediumSelect a mediumOil PaintingAcrylic PaintingWatercolour PaintingMixed Media2D dimensional mediaPrintmakingPhotographyDigital graphics3D mediaSculptureJewelleryTextileEmbroideryStitch
Price$
Artwork 3 (optional)
Entry fee is $40 per entry (non-refundable), limited to 3 entries.
Bank Account for Payment of Entry Fee: Otago Art Society Inc. 02-0929-0274457-000
Bank Reference — Particulars: Your Name, Reference: Cleveland
Entry Fee Paid Via (required)Direct CreditOAS Gallery Shop
Date Paid (required)
Amount (required)Select amount$40$80$120
Please email a photo of each artwork to otagoartsociety@xtra.co.nz, naming each file with your full name and the artwork title.
Date Photo Submitted (required)
Are you a member of the Otago Art Society? (required)YesNo
Do you consent to your artwork being sold through layby? (required)YesNo
Tick only those that apply to you.
I will pick up unsold artworks myself
I authorise someone else to pick up the unsold artworks on my behalf
I am from out of town and have included my pre-paid return courier ticket
If you authorised someone else, please name them here
I agree to the Terms and Conditions of the Cleveland National Art Awards as outlined on the pages issued prior to this Entry Form. I certify that the entry fee has been paid.
Signature — type your full name (required)
Date (required)
