2023 Exhibition Entry Form

TO COMPLETE THIS FORM YOU WILL NEED

A reference for your exhibition entry fee (date paid, bank or Paypal reference is acceptable)
Your contact details
Your ABN (if you have one)
Your artwork details including: Title, materials/medium, height, width and depth(if 3D), and artwork price.

Name*

First NameLast Name

Address*

Street Address Line 1

Street Address Line 2

CityState

PostcodeCountry

Mobile Phone Number*

Please enter mobile number.

Landline Phone Number

Please enter landline phone number.

Email*

example@example.com

Australian Business Number (ABN) :

Is This a Youth Entry*

YesNo

Age Last Birthday

Are you eligible for the Fairfield City Residents Prize?*

YesNo

Artwork 1 title :*

Medium Artwork1:*

(Optional) Please upload image of Artwork 1 if available:

Please give details:

Size including frame in cm:*

(width x height)

Is this artwork to be considered for the Peter Adrian Markwick Memorial Prize?*

YesNo

Price:*

Is your Artwork1 3-D?

YesNo

Enter another artwork?

YesNo

Artwork 2 title :

Medium Artwork 2:

Please upload image of Artwork 2 if available

Please give details:

Artwork 2 Size including frame in cm:

(width x height)

Is this artwork to be considered for the Peter Adrian Markwick Memorial Prize?*

YesNo

Artwork 2 Price:

Is your Artwork2 3-D?

YesNo

Are you a current FAS member?*

YesNo

Do you wish to join or renew membership?

Join/RenewNo

Please visit: Join

Are you claiming a pensioner discount?

YesNo

1.Please pay total fees shown below:
Joining/Membership fee:	Not Applicable
Members work1:	Free
Members Work2:	Not Applicable
Non-members work1:	Not Applicable
Non-members work2:	Not Applicable
	___________
Total Fees:	$Nil

2.Please pay total fees shown below:
Joining/Membership fee:	Not applicable
Members work1:	Free
Members Work2:	$35
Non-members work1:	Not Applicable
Non-members work2:	Not Applicable
	___________
Total Fees:	$35

3.Please pay total fees shown below:
Joining/Membership fee:	$20
Members work1:	Free
Members Work2:	Not Applicable
Non-members work1:	Not Applicable
Non-members work2:	Not Applicable
	___________
Total Fees:	$20

4.Please pay total fees shown below:
Joining/Membership fee:	$15
Members work1:	Free
Members Work2:	Not Applicable
Non-members work1:	Not Applicable
Non-members work2:	Not Applicable
	___________
Total Fees:	$15

5.Please pay total fees shown below:
Joining/Membership fee:	$20
Members work1:	Free
Members Work2:	$35
Non-members work1:	Not Applicable
Non-members work2:	Not Applicable
	___________
Total Fees:	$55

6.Please pay total fees shown below:
Joining/Membership fee:	$15
Members work1:	Free
Members Work2:	$35
Non-members work1:	Not Applicable
Non-members work2:	Not Applicable
	___________
Total Fees:	$50

7.Please pay total fees shown below:
Joining/Membership fee:	Not Applicable
Members work1:	Not Applicable
Members Work2:	Not Applicable
Non-members work1:	$35
Non-members work2:	Not Applicable
	___________
Total Fees:	$35

8.Please pay total fees shown below:
Joining/Membership fee:	Not Applicable
Members work1:	Not Applicable
Members Work2:	Not Applicable
Non-members work1:	$35
Non-members work2:	$35
	___________
Total Fees:	$70

Youth entries are free of charge - Youth is defined as those artists who have not reached their nineteenth birthday by the 27th October 2023 (closing date of entries)

All fees are payable to Fairfield City Art Society Inc. by:

1. Direct transfer to bank account:
BSB: 062217
Acc No: 10340711

2. PayPal:
Please copy Link below into your PayPal account and pay as Friends:
admin@fairfieldcityart.org

*Payment reference FAS then Surname & Initials, eg:FASJonesJA
*Receipt of payment made by bank transfer must be emailed to
admin@fairfieldcityart.org

I have paid the required fees*

Yes

Payment Details *

Terms and Conditions*

Date

Fairfield City Art Society Inc.

30th Fairfield Art Prize Annual Exhibition 2023