Back                            

Artwork Registry  Application form 
                                                    (Print it fill it up & mail it)

                                                   

 

Applicant must state, explain & submit the following:

The undersigned applicant herby submit the present form, state & represents that he is the artist, owner or

agent of the described artwork & has the right to enter into this application. Holds harmless & indemnifies

Artwork Registry from any claim or damages for violation of this representation & that the statements in this

application are correct to the best of my knowledge.

 

1-Title given to the artwork:...................................................................................................................
                                                                                                     (title  given  to the Artwork to be named as)

2-Specify the object of the artwork:........................................................................................................
                                                                                                                     (oil painting,  acrylic, drawing, print craft, sculpture etc.)

3-Dimensions of the artwork:.................................................................................................................
                                                                                                                                                         (exact measurement per inches )

4-Year the artwork was created:............................................................................................................
                                                                                                                                                                           ( day - month - year )

5-Artist full name & country of origin:......................................................................................................
                                                                                                                   (artist first - middle - last name & the country he is from )

6-Applicant's full name:........................................................................................................................
                                                                                                                                                   ( applicant name first - middle - last )

7-Applicant's full address:.....................................................................................................................
                                                                                                                                              ( street - number - city - state - country)

8-Applicant's phone, fax & email:...........................................................................................................
                                                                                                                               (country code, area code, phone number & email)

9-Submit photograph that best represents the artwork  (color photograph 3x 5 inch approx.)
                                 &n