Required fields are marked with asterisks (*)

Artist Agreement Form

Form for those wishing to loan or donate artwork to the municipality.

Contact Information:

First Name:

Last Name:

Address:

City or Town:

Province:

Postal Code:

Email Address:

Phone Number:

Artwork Information

Name of Artwork:

Description of Artwork: Outline the media used, the physical dimensions and explain the story behind the artwork.

Is a Maintenance Plan required for the artwork?

Yes

If yes, please provide the details of the maintenance plan.

How are you submitting your artwork?

Loan

Donation

If loaning, indicate the time period of the loan:

If donating, are you requesting a tax receipt for this donation?

Yes

If donating and requesting a tax receipt, please attach a bill of sale or an appraisal from a certified member of the Professional Association of Art Dealers in Canada or the Certified Guild of America.

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

I, hereby, free the Township of Ramara from all liability in case of accidental loss, theft, damage, or vandalism to the specified artwork.

Date:

Notice of Collection: The personal information recorded on this form is collected and maintained in accordance with MFIPPA - the Municipal Freedom of Information and Protection of Privacy Act and will be used for the sole purpose of processing your request. Questions about the collection of personal information may be addressed to the Records and Information Coordinator, Township of Ramara, 2297 Highway 12, P.O. Box 130, Brechin, ON L0K 1B0, 705-484-5374.

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Artist Agreement Form