Submission Form - Held/NotHeld

Thank you so, so much for giving your time to this project. I can't wait to receive your piece/s.

Contributor Details:

Full Name

Preferred Credit Name *

Full Name
First Name only
Initials
Anonymous

Email *

Phone(optional)

I am a *

Mother
Partner
Midwife
Doctor
Doula
Other (please elaborate below)

If you selected Other, please elaborate:

I can confirm that I am: *

Over 18
The contributer is under 18. I am their parent/guardian and signing this form on their behalf

Parent/Guardian Name

Relationship to Contributer

About your submission

How many tiles are you submitting *

1
2
3
4 or more

Optional - What is the inspiration for your piece/s. Feel free to share as little or as much as you would like about your story.

Are you happy for me to share your story?

Yes, for exhibition purposes only
Yes for exhibition, social media and other purposes listed in section 3 of the Terms and Conditions of this project
No, please don't share this.

Optional - When did you give birth/support a birth (you can select multiples)

2021-2026
2015-2020
2010-2014
2004-2009
2000-2008
1990-1999
1980-1989
1970-1979
1960-1069
1950-1959
1940-1949
1930-1939
1920-1929
1900-1919

Declarations

I confirm this carving is my own original work, and I have not copied it from another artist or source I do not have rights to use.

I have read and agree to the attached Terms & Conditions, including the licence granted to the Artist to reproduce and exhibit my work as part of the collective artwork.

I consent to my name and submission details being held for the purposes of this project, as described in the Terms & Conditions.

I am happy for my piece to be considered for use on fabric, promotional materials, or other products connected to the project (see Section 3 of the Terms & Conditions).

If you leave the box above unticked, your piece may still be included in exhibitions and online, but will not be used for the additional purposes listed in Section 3 unless you separately agree.

Signature (contributor, or parent/guardian if under 18): *

Clear

Thanks for getting in touch!

Thank you for your submission. I will be in touch with you soon.

Have a great day!

Thanks for getting in touch!

Thank you for your submission. I will be in touch with you soon.

Have a great day!

Country/region

Thank you for your submission

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