Medalta International Artists in Residence Program 2008
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COMPLETE application must be submitted by April 18th, 2008
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Personal Information

First Name

Last Name

Phone number(   )

Fax number(   )

Street Address

City

Country

State/Province

Zip/Postal Code

Email Address

Contact preference:  Email or  Phone or  Fax 

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The following must be submitted to assure consideration for the residency
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10 slides of your current work included ? YES    ? NO

Brief Biography & artists statement

Non-Refundable application fee of $15.75 (including GST)

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Payment Method   ? Visa  ? Master Card  ? Personal Cheque   

made out to: (Medalta International Artists In Residence)

Is the deposit included    YES    NO

Card Number:

Expiry Date:

Do you require a receipt mailed to you?      YES  NO

Signature:

Are you the main Card Holder  YES  NO

All fees are calculated in Canadian Funds

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FEES:
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Residency fee is $500.00 + GST
Non-Refundable Application Fee $15.00 + GST 

The Full Residency fee is $540.75 including 5% GST 

Have you included all required information with this application ?YES    NO

Did you submit a letter of intent including an indication your working 
preference e.g. wheel, hand building sculpture,  YES   NO 

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Mail your completed application to:

Medalta International Artists In Residence
713 Medalta Avenue South East
Medicine Hat , Alberta
Canada, T1A 3K9