Title of Exhibition:

MEMBERS' AUTUMN EXHIBITION

Name

First Name

Last Name

Phone Number

MAS Member

Yes

No. Entry is limited to members only

Bank Account No

GST Registered

Yes

Title of Work

Medium

E.g. Oil on canvas, watercolour, pencil, mixed media etc

Size

Price

Payment Method if unable to supervise

MAS bank account number is 03 0599 0243403 00. Please use Autumn as the reference

Supervising at Gallery

Please state your preferred day, date and either morning (10.30am to 1.30pm) or afternoon session (1.30pm to 4.30pm) Please note that if you choose not to supervise then a $20 fee is applicable in addition to the entry fee.

Please indicate if you are happy to share your supervising session, either with another person at the same time or to split the 3 hours (please note that we will accommodate individual requests as far as we are able to but this may not always be possible)

I prefer to supervise alone

I am happy to supervise with another person

I would prefer to split the 3 hours into two 1.5 hour shifts

If unable to collect my art at conclusion I have arranged for the following person to collect on my behalf

Please advise name, phone number and/or email address

Signature and Date

I understand and agree to the Conditions of Entry for Exhibition as explained on Conditions of Entry page