LUX, 3rd Floor, 18 Shacklewell Lane, London, E8 2EZ, UK

DISTRIBUTION SUBMISSION FORM

Please enclose this form along with your preview tape/ DVD and a stamped addressed envelope if you want the material returned. Please note LUX cannot be held responsible for work sent to us. Do not send master copies
Send to NEW ACQUISITIONS, LUX, 3rd Floor, 18 Shacklewell Lane, E8 2EZ, UK



Please complete in black ink or type

		








	






Please list the work(s) you are submitting to LUX Distribution including title, date produced, exhibition format, exhibition history.
























Short Biography




















Short statement about the submitted work(s)













Equal Opportunities Monitoring Form
Data Protection Act 1998: Equal opportunities information will be used only for monitoring the performance of the organisation and not for selection purposes.

1. Please look at the descriptions of race and ethnic origin listed
below and circle the one that most accurately describes you.

Black or Black
British
Caribbean 
African 
Other 

Asian or Asian
British
Indian 
Pakistani
Bangladeshi 
Other 

Mixed
White & 
Black Caribbean
White & Black
African 
White & Asian 
Other 

White
British 
Irish 
Other 

Chinese 

Other Ethnic 
Group (please state)

2. Gender:

Female 	Male 

3. Do you have a disability?

The Disability Discrimination Act 1995 defines disability as a physical or mental impairment which has a substantial and long term (for more than 12 months) adverse effect on a person's ability to do normal daily activities. You may still be considered to have a disability if you are not currently adversely affected but the impairment is likely to recur.

No  	Yes