Artists Shorts Registration Form

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ARTISTS SHORTS: AN UNFINISHED WORLD Modern Art Oxford, Thursday 16 February 2012 REGISTRATION FORM Thank you for

submitting work to Modern Art Oxford for this event. Please complete this form and post it with your DVD to: Melanie Pocock, Exhibitions Associate, Modern Art Oxford, 30 Pembroke Street, Oxford, OX1 1BP The deadline for applications is: Wednesday 1 February 2012. NAME: EMAIL: TELEPHONE: UNIVERSITY: PLEASE TICK: UNDERGRADUATE/POSTGRADUATE/TUTOR/ALUMNUS TITLE OF WORK: DATE: DURATION:

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