LOGIN INFORMATION

Email *

Re-enter 'Email' *

(duplicate - as 'Email')

Choose Password *

Re-enter Password *

(duplicate - as 'Choose Password')

PRIMARY CONTACT INFORMATION

First name *

Last name *

Phone Number *

Cell Number *

(Please use international format: +2782555777)

Position in company*

AGENCY / INDIVIDUAL INFORMATION

VAT Number: (South African companies please enter your VAT number. If you leave this field blank your VAT number will not be added to the invoice. International entries, Educational institutions, students and non-VAT registered individuals should leave blank.)

Company Name *

Company Type *

VAT Registration No.

Phone Number *

Fax Number

Web Site

Number of employees *

Please enter the total number of employees at your company. We will use this to group your company into small, medium or large. If you are a freelancer or part of an educational institution, enter '1' here.

SECONDARY CONTACT INFORMATION

If you have any additional contacts at your company, please enter their names here, otherwise leave blank.

Contact Type

First Name

Last Name

Phone Number

Email

Contact Type

First Name

Last Name

Phone Number

Email

PHYSICAL (STREET) ADDRESS

This needs to be a physical (NOT PO BOX) address to where packages can be delivered via courier. Do not retype your name or company - just provide the relevant building name, street address, and post code.

Address Line 1 *

Address Line 2 *

Postal/Zip Code *

Town/City*

Province/State *

Country *

POSTAL ADDRESS

Please include your postal address here (E.g. PO Box). Do not retype anything already entered above such as your name or company. All we want is a PO Box or street address, suburb and postal/zip code.

 

Same as Physical Address

Address Line 1 *

Address Line 2 *

Postal/Zip Code *

Town/City*

Province/State*

Country *

I WOULD LIKE TO RECEIVE UPDATES FROM THE LOERIES

Opt-in for updates on entry deadlines, finalist announcements, event information, ticket bookings, and more.

 

via email **

No
Yes

 

via mobile messaging **

No
Yes

ADDITIONAL CONTACTS

Please list any contacts that you would like to receive finalist and winner notifications.

First Name

Last Name

Phone Number

Email

First Name

Last Name

Phone Number

Email

TERMS AND CONDITIONS

I accept all the terms and conditions of The Loerie Awards

HUMAN VERIFICATION

Lastly, please verify you are a human.