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CEN 20TH Anniversary Amateur Photographic Competition
ENTRY FORM

Closing Date for entries: 4:30 pm on Wednesday 17th May 2017
Exhibition Period: Friday 26th May to Wednesday 31st May 2017
Exhibition Venue: The Entrance Gallery

First Name *

Last Name *

Organisation

Address

Address2

Suburb

State

Postcode

Country

Select country Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-bissau Guyana Haiti Heard and Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Barthelemy St. Eustatius St. Helena St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand The Democratic Republic of Congo Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe

Phone *

Mobile

Email Address *

Amount *

Club or School

Categories

Youth

Adult

Please enter titles in the appropriate categories for any photos that you are submitting

Flora - monochrome

Title 1

Title 2

Title 3

Flora - colour

Title 1

Title 3

Title 2

Fauna - monochrome

Title 1

Title 2

Title 3

Fauna - colour

Title 1

Title 2

Title 3

Title 1

Waterways/ Underwater/ Landforms - monochrome

Title 2

Title 3

Waterways/ Underwater/ Landforms - colour

Title 1

Title 2

Title 3

Total Entry Fee to be paid: $ *

Delivery: by 4:30 pm on Wednesday 17th May 2017

For full details see “Information - Terms and Conditions” - Including details of delivery

Enquiries: Barbara Gorman (02)4332 3597

Total Amount

$

Payment method *

Paypal (Credit Card)
into Account Name: CEN BSB No:062628 Account No: 10095830 Ref:__________ {Entrant’s name}
by CASH ONLY when delivering entries by hand

Billing Zipcode*

Credit Card Number*

Expiration Date*

01 02 03 04 05 06 07 08 09 10 11 12 / 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032

Card (CVV) Code*

Card Type*

Visa MasterCard Discover American Express

Card Holder Name*

Verification code*

Contact details

CALL 02 4349 4756

FAX 02 4349 4755

PO Box 149 Ourimbah NSW 2258

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The Manor, Central Coast Campus
University of Newcaste
Brush Road Ourimbah
NSW

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