NAME (REQUIRED FIELD)

DO YOU CURRENTLY OWN THE WORK?

COUNTRY

CITY

EMAIL (REQUIRED FIELD)

TITLE OF THE WORK

YEAR

MEDIUM (REQUIRED FIELD)

DIMENSIONS (REQUIRED FIELD)

EDITION NUMBER (IF APPLICABLE)

EXACT SIGNATURE, TITLE AND DATE, AND THEIR LOCATION ON THE WORK

PHOTOGRAPH OF THE WORK

PHOTOGRAPH OF SIGNATURE AND DATE

FROM WHOM DID YOU ACQUIRE THE WORK

DATE YOU ACQUIRED THE WORK

IF APPLICABLE TO WHOM DID YOU TRANSFER THE WORK

EXHIBITIONS AND/OR PUBLICATIONS THE WORK HAS APPEARED IN

HOW WOULD YOU LIKE TO BE LISTED IN A POSSIBLE PUBLICATION (EXAMPLES: YOUR NAME; YOUR NAME WITH CITY DESIGNATION; “PRIVATE COLLECTION”; “PRIVATE COLLECTION” WITH CITY DESIGNATION)