Registration form:

Please copy/paste this form into a word doc, then type in on the computer, we do not accept handwritten forms to avoid misunderstandings from handwriting.

---- DEADLINE February 20, 2012.----

Sex, Drugs & Rock’n Roll... VICES OR LIFESTYLE ?

Registration no: (to be completed by the organisation) ____________________

Artist Name:

Company/Studio Name:

Address:

Postcode/City:

Country:

Telephone:

Email:

Website:

Title of Artwork:

Please check as appropriate:

0 ring

0 brooch

0 bracelet

0 necklace

0 other

Dimensions:

Media/Materials used:

Description of piece:

Technical description:

Source of Inspiration: (use additional page if you need more space)

The undersigned declares to have taken note of and to be in agreement with the terms of the contest as outlaid in the Open Call for Artists.

Location: ______________________________________________

Date: _________________________________________________

Signature: _____________________________________________

Please forward this form (all pages) with all necessary documentation (photos, CV, info about the artist, design form) via email, and together your payment of $25 via paypal on or before February 20, 2012.

Send to: vices.lifestyle@gmail.com

Applications that reach us after Feb 20, 2012 cannot be considered.