ENTRY FORM

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PERSONAL INFORMATION

Artist's Name (please PRINT) First _____________________Last_____________________________

Address: __________________Street _________________________________Apt. # ____________

City __________________________Province/Territory_______________Postal Code ____________

Phone: (_______) _______- ___________ email: _________________________________________

Title of painting:____________________________________________________________________

Medium:_________________________________________________________________________

Dimensions (centimetres): height_______________cm; width___________ cm; depth _________ cm.

DECLARATION BY ARTIST:

Preferred language: ___ English ____ French

To be eligible for consideration, you must sign below to confirm all of the following statements:
· I am a Canadian citizen or permanent resident (landed immigrant) of Canada.
· I have read the rules of the Kingston Prize competition, and accept the conditions of the competition.
· I acknowledge that the decision of the Jury is final and binding on myself and on other participants.
· I met with the subject of my painting and he/she sat for me.
· I certify that the statements in my application are true and complete, to the best of my knowledge.

Signature of Artist:________________________________________________ Date:_____________

DECLARATION BY SUBJECT:

Name(s) of subject(s): _____________________________________________________________
Please PRINT

Preferred language: ___________________________ English _______________________ French

· I am a Canadian citizen or permanent resident (landed immigrant) of Canada.
· I met with and sat for the artist for the purpose of making this portrait.
· I certify that the statements in the application are true and complete, to the best of my knowledge.

Signature of Subject:_______________________________________ Date:___________________

For group portraits, only one of the subjects need sign.

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