The 25th UBE Biennale International Open Sculpture Competition 海外出品用 Application Form ＊Office Use Only 受付番号 出品料 (※Office use only)

・ Please write in English or Japanese. ・ Fill in the blanks framed with thick line. Please tick the appropriate box. Application Date / / 2012 Sex □Male □Female Installation of model First Name Last Name 搬 入 Occupation □Deliver in Person □Deliver via Post Date of Birth / / Age Attach the payment certificate Address 搬 出 Place of Birth

City Country Zip code Telephone Number Website http:// 破 損 E-mail @ Facsimile Number

入 選 Title of Work

Total deimensions must not exceed 900cm Size of actual work Material of actual work H ×W ×D cm 販 売 Total deimensions must not exceed 90cm Size of model Material of model H ×W ×D cm No more than 10,000kg Weight of actual work Agreement

Attach image of the model ＊Please indicate the front. I/We agree to the Guideline and apply to the 25thUBE Biennale.

date month 2012

Signature

Special arrangement for return of model

Do you want the model to be returned? ＊Shipping fee must be pre-paid. □Yes □No

Sales of your model

If someone wants to purchase your model, will you allow the secretariat to tell him/her your E-mail address? □Yes □No CV Please write your resume within 10 items. Winners’ CV may be used for publicity purpose. 受付番号 (※Office use only)

Name

Questionnaire

１ How did you hear about this competition?

□ E-mail from the Secretariat □ UBE tokiwa Museum’s Website □ Others

２ Have you ever applied for this competition?

３ How did you get interested in this competition? Statement Please write about your work’s concept within 200 words. Winners’ statement may be used for publicity purpose.

４ If you have any comments on us, please write here. ＊Detach this slip and attach to the bottom Work Slip ＊Please keep this slip with you. ＊Please send the completed application ① surface of the model. ③ Copy Addressee form to the address below. 受付番号 UBE tokiwa Museum (※Office use only) Name Address：3-4-29 Nonaka,Ube city, , 7550025, Tel : +81-836-37-2888 Fax : +81-836-37-2889 Title of work E-mail：[email protected] Name Website：http://ube-museum.jp

Access Transport to UBE tokiwa Museum (Tokiwa Park)

Title of work ● By Airplane From () to Yamaguchi Ube Airport：1 hour 30 minutes 10 minutes from Yamaguchi Ube Airport to Tokiwa Park by taxi.

● By Shinkansen Line From Tokyo to Shin-Yamaguchi : 4hours and 40 minutes. (The Bullet Train) From Shin-Yamaguchi to Tokiwa Station : 25minutes by train. From Tokwia Station to Tokiwa Park : 30minutes walk or 5minutes by taxi. Cut off line ● Work Slip By Car ② 10minutes from Ube Higashi I.C. on Sanyo Expressway. ＊Detach this slip and attach to the top of the package. Route 316 Route 490 Route 2 - Yamaguchi St. The nearest parking lot is ＊Attach image of the model to the top of the package. Shin

Cut off line off Cut "Parking Nishi" in Tokiwa Park. 400 yen for ordinary vehicles parking, 1,600yen for large vehicles parking. 受付番号 Asa St. Line (※Office use only) Route 2 Line Line JR Sanyo ShinkansenJR Sanyo

Route 190 JR Ube Sanyo Expressway Name Yamaguchi Ube Road Tokiwa Lake

Onoda St. Tokiwa Lake Hall Ube St. UBE tokiwa Museum Ube JCT Ube IC Annex UBE tokiwa Museum Title of work Ube City Ube Higashi IC Route 190 Coal Mining History Museum

Yamaguchi Ube Road Ube Shinkawa St. Tokiwa Park (※Office use only) 海外出品 Tokiwa St. 搬 入 搬 出 破 損 入 選 Yamaguchi Ube Airport Tokiwa St.