Jeremy Geddes Art

Lottery Registration Form for Set One
Three prints in set with an edition of 30
$900AU (includes flat pack and courier)

Registration must be with email linked to paypal

* indicates required

Paypal Email Address *

First Name

Last Name

Delivery Address *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Provide your best daytime delivery address

Telephone Number *

Provide your daytime telephone number for courier

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