Indigenous Art Code Limited (ACN 139 788 711)
ArtistMember Application Form

APPLICATION for membership of Indigenous Art Code Limited (ACN 139 788 711) as anARTIST MEMBER

ARTISTMember Application Form

Terms defined in this form have the meaning given to them in the Constitution of Indigenous Art Code Limited (ACN 139 788 711) (the Company).

Once you have completed and signed this form, please submit a copy via email to or via post to:

Gabrielle Sullivan, CEO Indigenous Art Code
The Gunnery, 43-51 Cowper Wharf Road
Woolloomooloo NSW 2011

Your responses to the questions in this form will be confidential and reviewed by Directors of the Indigenous Art Code.

Only the information highlighted in green below will be made public on the Indigenous Art Code website.

Please contact Gabrielle Sullivan, Chief Executive Officer of the Indigenous Art Codeat if you have any questions in respect of this form.

I confirm that the information that I have provided in this form is true and correct.

Signed in the presence of:
Witness Signature / Signature
Print Name of Witness / Print Name of Applicant

Please respond to all questions, you can increase the space for your response by hitting return. Please return your document as a word file so that information can

be cut and paste directly into the Indigenous Art Code database. If you print the form and fill in by hand please use neat handwriting.

If you require assistance to complete the form please contact Gabrielle Sullivan 0438 637 862 or

Contact Information

Question / Applicants Response
1 / Name of Applicant:
2 / I declare that I am, an artist of Aboriginal and/or Torres Strait Islander descent, and that I identify as Aboriginal and and/or Torres Strait Islander, and am recognized as such by members of the community with which I identify. / YES
NO
3 / Residential address
4 / Postal address
5 / Telephone number
6 / Email address
7 / If you are a member of an Indigenous Art Centre please name the art centre[s] / Important Note: The Directors intend to identify on the Company's website those Members who wish to be associated with their member art centre[s]. Please tick this box if you do not want this type of information identified on the Company's website.
8 / Preferred method of contact
9 / Please list all Indigenous Artwork that you create.
(For example: Original works such as paintings on bark, paintings on canvas, original works on paper, edition prints, digital media, sculpture, Yidaki-Didgeridoo, artefacts, textiles, fabrics and fashion. Merchandise such as publications, stationery, jewellery, furniture, homewares and body products.)

NOTE: The information in the highlighted green columns will be included in your listing on the Indigenous Art Code website.

Upon completion of the Boards assessment of your application, the Indigenous Art Code will confirm your information with you before uploading to the website.

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