Gallery Submission

First Name *

Last Name *

What name would you like displayed publicly? *

Email *

Phone Number *

State *

Age at last birthday *

Artistic Experience *

Postcode *

Title of work *

Medium *

Are you of Aboriginal or Torres Strait Islander origin? *

How does your artwork reflect the theme of Palliative Care… It’s more than you think? *

Words remaining: 100

I confirm that I am aged 18 years or older OR I am aged under 18 years and I confirm that I have sought permission from my parent/carer

I confirm this entry is my own work

The collection of personal information complies with Palliative Care Australia’s Privacy Policy and the Privacy Act 1988 (Cth).

Image
* The minimum image dimensions: 600px X 600px.
* Allowed file types: .jpg, .png
* Maximum file size: 4MB

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