DMA

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 * (For billing purposes, name appears on invoice) :

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.

Independent Agency? *:

No

Yes

SECONDARY CONTACT INFORMATION

If you have an additional contact for your company, please enter their details here, otherwise leave blank.

Position in company* :

First Name :

Last Name :

Phone Number :

Cell Number * :

Please use international format: +2782555777

Email :

via email *:

No

Yes

via mobile messaging *:

No

Yes

Position in company* :

First Name :

Last Name :

Phone Number :

Cell Number * :

Please use international format: +2782555777

Email :

via email *:

No

Yes

via mobile messaging *:

No

Yes

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 :

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.

Registration

LOGIN INFORMATION

PRIMARY CONTACT INFORMATION

AGENCY / INDIVIDUAL INFORMATION

SECONDARY CONTACT INFORMATION

PHYSICAL (STREET) ADDRESS

POSTAL ADDRESS

I WOULD LIKE TO RECEIVE UPDATES FROM THE LOERIES

ADDITIONAL CONTACTS

TERMS AND CONDITIONS

HUMAN VERIFICATION

Contact DMA Support

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