FULL NAME OF ARTIST: ____________________________________________________

NATIONALITY: ___________________________________________________________

CONTACT ADDRESS: _______________________________________________________

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 TOWN: _________________________________________________________________

COUNTRY: _______________________________________________________________

TELEPHONE: _____________________________________________________________

E-MAIL: _________________________________________________________________

WEBSITE: ________________________________________________________________

NUMBER OF WORK (S) ENTERED: ______________________________________________

TITLE (S) OF WORK (S) ENTERED AND MEDIUM OF EXPRESSION: _____________________

ARE THE WORKS FOR SALE?                 

ASKING PRICE FOR WORK (S) FOR SALE (IN NAIRA): _______________________________

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(A 30% COMMISSION SHALL BE DEDUCTED BY FICDATA FOR EVERY WORK SOLD)

ARTIST’S STATEMENT/BRIEF BIO-DATA: _________________________________________

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Note: Submitting this form implies your full acceptance of all conditions and terms for membership/ participation in FICDATA bi-annual advocacy art exhibition/social development campaign