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Name
Surname
Nom de Plume
Tel No.
Cel No.
e-Mail address
Website

Physical address:

 
Unit No.
Street name
Suburb
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Postal code

Postal address:

Same as above ( Y/N )  
P.O. Box
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Media you work in:

(Can choose muliples)
1. Oils  ( Y/N )
2. Water colours  ( Y/N )
3. Acrylic  ( Y/N )
4. Pastel  ( Y/N )
5. Sculpture  ( Y/N )
6. Needlework  ( Y/N )
7. Jewelry  ( Y/N )
8. Pottery  ( Y/N )
9. Other  ( Y/N )
Detail other
Photos Size 345 X 230
About artist ± 500 Words
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