WordPress Art Competition Registration Form

First Name*

Last Name*

Gender*

MaleFemaleN/A

Date of Birth*

Mobile Number*

Email*

Address*

Address Line 1

Address Line 2

City

State or Region

Country

Zip

Title of Artwork*

Medium/Technique Used*

Dimensions*

Description*

Special Requirements*

Gallery DisplaySpecial LightingEquipment AssistanceOther(Please specify)

Terms and Conditions *

I hereby confirm that the information provided is accurate and complete to the best of my knowledge. I agree to abide by all rules and regulations of the competition and grant permission for the use of my artwork for promotional purposes related to the event. I acknowledge that my participation is at my own risk and that the organizers are not liable for any damages or losses