Name:
Trading Name (if Different):
Residential Address:
Postal Address:
Other Address (eg. studio):
Phone:		Mobile		Fax:
Email:			Website:

Would you like to be listed publicly on the Burnie City Council Artist Database?
Yes		No

Please provide an artist profile (up to 100 words)

Would you also like to be listed to the artist databases of other arts bodies?
Yes		No

Are you a member of a local cultural organisation? If so, who?

What would you consider your involvement in the arts practice in Burnie is?

Professional F/T Professional P/T Hobbyist

Are you registered for GST?
Yes		No
Do you have an Australian Business Number?
Yes		No
If so, what is your Australian Business Number?

What training, if offered, would you be interested in to develop your artform or business practices?
Mentoring		Grant Writing		Business Basics
Artist Development		Artist Networking		Marketing
Taxation/GST/ABN		Artist Management		Event Management
Other

What art form/s is/are you practising in?
Literary Arts		Visual Arts		Performing Arts

What genre/s is/are you practising in?
Visual Arts:
Painting		Watercolour		Oils		Prints
Crafts		Pastel		Acrylic		Charcoal
Mixed Media		Collage		Etching		Screen Print
Photography		Film		Graphic Design		Mosaic
Furniture		Fashion		Textiles		Illustration
Leather		Multimedia		Printmaking		Sculpture
Drawing		Plastics		Other

Literary Arts:
Poetry		Children's		Fiction		Non-Fiction
Critical		History		Other

Performing Arts:
Music		Acting		Comedy		Magic
Circus		Modelling		Dance		Street Theatre
Direction		Production		Other

If music then what style?
Rock		Jazz		Pop		Punk
Big Band		Swing		Classical		Blues
Grunge		Metal		Hip-Hop		Rap
Acoustic		Funk		Alternative		Country
A Capella		Electronic		Techno		Gospel
R&B		Dance		Folk		Instrumental
Ska		Reggae		Psychodelic		Industrial
Comedy		Children's		Adult		Choral
Ambient		Soul		Christian		New Age
World		Other

If music then what format?
Solo		Duo		Band		Big Band
Karaoke		DJ		Other