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NeuroSoc Submission form .pdf


Original filename: NeuroSoc-Submission-form.pdf
Title: Microsoft Word - NeuroSoc Submission form.docx
Author: Kevin Jimenez

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You must print and complete this form to attach with your entry. Please write in black ink and BLOCK
CAPITALS. The deadline for submission is Wednesday 15th April, 2015.

The Brain and Mental Health:
UCL NeuroSoc Art Exhibition Submission Form
First  Name:  

Surname:  

E-­‐mail  address:  
Entry  Title  (max  20  words):  
Artwork  Description  (max  250  words):  This  information  will  be  publicly  displayed  so  please  check  your  grammar  
and  spelling  thoroughly.  We  will  notify  you  if  we  feel  your  description  requires  editing.  Please  complete  on  a  
separate  sheet  if  necessary.
 

Materials  (e.g.  oil  on  canvas):  
Approx.  Weight:  
Dimensions  (width  x  length):  

                                                                   kg  

                                                           g  

                                                                         mm  

                                                                   mm  

Please  note  that  entries  larger  than  A3  (297  x  420  mm)  must  be  handed-­‐in  person  to  UCL  together  with  this  form  in  
April.    Drop-­‐in  dates  will  be  advertised  closer  to  the  date.    Smaller  articles  may  be  addressed  to  the  following  
address:  
 

UCL  NeuroSoc  Art  Exhibition  
Main  Post  Room  
Gower  Street  
London  WC1E  6BT  
 

To  feature  on  our  online  gallery,  please  upload  a  high  quality  photograph  or  scan  of  your  artwork  to  our  
DropBox  account  at  www.ucl.ac.uk/dropbox/  (organization:  UCLNeuroSoc;  e-­‐mail:  neurosoc@ucl.ac.uk)    
 

Completed  (Delete  as  appropriate)?    YES  /  NO  
 

Declaration
In  signing  below,  you  agree  to  UCL  NeuroSoc  exhibiting  and  auctioning  your  artwork.    50%  of  the  revenue  will  go  
to  the  charity  SANE  and  up  to  50%    (minus  listing  fees)  will  be  available  to  you  as  specified  during  registration.    
UCL  NeuroSoc  reserve  the  right  to  use  your  artwork  for  future  publications  and  we  cannot  guarantee  return  of  
non-­‐sold  items.    Additionally,  we  cannot  hold  liability  for  lost,  stolen  or  accidentally  damaged  artwork.    You  also  
confirm  that  this  entry  is  entirely  your  own  work  and  concept,  and  it  has  not  previously  been  published  or  
exhibited  elsewhere.    If  it  is  found  that  any  of  your  details  are  inaccurate,  UCL  NeuroSoc  reserve  the  right  to  
restrospectively  withdraw  entry  and  any  prizes  awarded,  including  auction  commission  without  appeal.  
Signature:  

Date:  

 
_  _  /  _  _  /  _  _  
 
 
 


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