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VANSAWESTERNCAPE

VANSA Western Cape Membership Form

by Erica — last modified 2009-11-23 17:49

How did you hear of VANSA?

Province (Required)

Please select the province where you are mainly based

----------------------------Personal Details------------------------------

First Name (Required)

Surname (Required)

Your E-Mail Address (Required)

Mobile Number

Work Number

Postal Address

Please include City, Country, Postal Code

Physical Address

Please include Postal Code, City and Country

Birth Date

/ /

Gender

Female
Male

Nationality

Race

Required by our funders, and for reporting purposes - you help us out by filling this in!

Where are you situated in the Western Cape

Cape Peninsula

Boland Winelands

Central Karoo

Garden Route

Little Karoo

Overburg

West Coast

If situated in Cape Town, which area?

Job Title / Function

Most recent formal qualification?

Year of Completion (Formal Training)

Other Training Received

Date of Completion

----------------------------As an Artist---------------------------------------------------

What Mediums do you use?

Please choose appropriate choice

How would you mainly describe your role in the Visual Arts Industry

Artist

Curator

Gallery / Dealer

Writer

Association

Educator/Facilitator

Service Provider

Service provider

Student

Do you teach artistic skills?

Where do you place yourself on the scale below

Choose 1 if you are an Emergent Artist or Choose 5 if you are an Established Artist. If you feel that you are in between the two stages,Choose the number that best explains where you are as an artist

1 - Emergent Artist
2
3
4
5 - Established Artist

----------------------------Business Details---------------------------------------------

Do you work as part of a business?

Yes
No

Name of Business

Type of Business

CC
Co- operative
Governmental
NGO
Non profit community
NPO
Pty Ltd
Section 21
Sole Trader

Age of business in 2009

Number of Employees in 2009

Estimated Turnover in 2009

----------------------------Exposure within the Industry----------------------

Are you represented by a Gallery?

Gallery Name

Province

Gallery Province

Town

Gallery Telephone Number

Have you exhibited before?

Yes
No

If yes, please give brief details

(solo/ group/ where/ when / locally / nationally/ overseas)

----------------------------Your needs as an Artist-------------------------------------------------

What are your greatest needs as an artist?

What courses would you like to see VANSA doing?

Are there any other areas in which you need assistance in?

subscription information

individual : R60 per annum
organization: R250 per annum
- Corporate/Company R500 per annum
please deposit membership subs into the following bank account:
Visual Arts Network of South Africa
Nedbank Gardens
Account Number: 1010103199
Branch Code: 00101009
Reference: Surname & first letter of your name (or Co/Org Name)

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VANSAWESTERNCAPE

VANSA Western Cape Membership Form

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