Mercury Entry Form

(Only 59 days left to enter)

Entry Fees

Member

£400.00

Non-Member

£500.00

Closing Date and Notes

The closing date for entries is 15/07/2012 at 23:59 hrs GMT.

* The entry fees are calculated as shown below:

	ITCA members	Non-members
First entry	£400	£500
Second and subsequent entry	£200	£250

Multiple entries from one Company can be accepted and the second/third etc entry will be charged at 50% of the relevant fee as above. The discount will be applied at the payment stage.

- One form per entry. Incomplete forms will not be accepted.
- Complete the entry form below – only electronic entry forms are accepted.

Entry Form Page 1

Fields marked with an asterisk (*)are required fields.

Your entry

Is this your companies second (or greater) entry in this year's competition?

Title of your entry *

Are you ITCA members?: *

About your Company

Company Name *
See rule 3

Business Type : *

Contact

Title*

First Name*

Family Name*

Job Title*

Email*

International Phone*

Fax

Address

Address Line 1*

Address Line 2

Address Line 3

Town*

Country*

Postcode/ZIP*

Continue

Please check the information you have entered above then press the Continue button once. You will be asked for the full details of your entry, then complete payment by credit card using Worldpay.

We agree to abide by the Rules of Entry