1

First Name

2

Surname

3

Address 1*

4

Address 2*

5

Town/City*

6

County*

7

Postcode*

8

Telephone*

9

Fax*

10

e-mail

11

Web site

12

Welsh speaker

Yes

No

13

Graduate 2000?*

Yes

No

Tick one or more of the following areas where you would consider working (see chart overleaf for details) You can tick all of them if you wish

14

Mid Wales

15

South Wales

16

West Wales

17

North Wales

18

19

20

Choose up to 3 art forms in order of priority (see list overleaf for categories). Your work may encompass more than one category e.g. Kinetic art and sculpture

1

2

3

21

Please send me information about jobs by (please tick)*

e-mail

post

22

Use this space to write a brief (about 300 characters) description of your work /practice

23

Date of birth (optional)**

24

Gender (optional)**

25

Registered disabled (optional)**

WORK AREAS - DEFINITIONS

North Wales

Angelsey, Gwynedd, Conwy, Denbighshire, Flintshire, Wrexham, North Powys

Mid Wales

South Gwynedd, Powys, Ceredigion, Wrexham, Merthyr, Rhondda Cynon Taff

West Wales

Ceredigion, Pembrokeshire, Carmarthenshire, Swansea, Neath & Port Talbot

South Wales

Neath & Port Talbot, Bridgend, Vale of Glamorgan, Cardiff, Newport, Monmouthshire, Torfaen, Blaenau Gwent, Caerphilly, Rhondda Cynon Taff, Merthyr

ARTFORM CHOICES

Painting

Installation Art

Sculpture

Mural

Printmaking

Mosaic

Graphic Art / Drawing

Ceramic

Photography

Glass

Film / Video

Jewellery

Environmental / Land Art

Furniture

Public art

Textiles

Community art

Artists' Books

Digital / Computer art

Kinetic / Automata

Sound / Audio Art

Craft Metal

Time Based / Performance / Live Art

Other (please state)

I would like to register for 1 year on the artX database

I enclose a cheque made payable to ARTEMESIA for:

FOR OFFICE USE ONLY

£15

Artists Registration

ID

Signed

Date

PW

Fill in the form in block capitals and return it to:

ArtX
P O Box 8
Narberth
Pembrokeshire
SA66 7YD

PD

DB