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Entry Form
Winners 2011
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Entry Form
OR Fill online below.
Entry Guidelines
Fill this form for each entry separately.
Supporting written document should be no longer than one side of an A4 size paper in no less than 10-point size Arial font.
Audio should be in mp3 format and should be limited to the duration specified for each category of awards.
Video, if any, should be MPG2 file format ONLY and be no longer than 2 minutes duration.
Select Category
Entry Name
*Enter Award Name
Award Sub Category Code:*
Select...
Select subcategory
Contact Details
Name of Entrant Company
*Enter Name of Company
Company Activity
select
Advertising Agency
Media Agency
Radio Station
Production House
Advertiser
Others
*Company Name Required
Address
* Address Required
City
*City Name Required
Pin Code
*Pin Code Required
Website
*Website Name Required
Contact Person 1
Name
*Name Required
Designation
*Designation required
Email
*Email required
*incorrect Format (name@domain.com)
Telephone number: Mobile/ Landline
*Mobile number is required.
*Enter 10 digit mobile number (eg:9023123331)
Contact Person 2
Name
*Name Required
Designation
*Designation Required
Email
*Email Required
*Incorrect Email (eg. name@domain.com)
Telephone number: Mobie/ Landline
*Telephone/Mobile Number Required
ENTRY DETAILS
Client/Brand:
*Enter Client/Brand
Activity/Script/Campaign Title
*Enter ScriptTitle
Date of Start of Activity
*Start Date Of Activity Required
CLIENT DETAILS
Address
*Address Required
Contact Person
*Contact Person Name Required
Email
*Email Required
*Incorrect Email (eg. name@domain.com)
Telephone number: Mobile/ Landline
*Telephone Number Required
*Enter Valid Number
Material being uploaded
HyperLink
*Upload File
HyperLink
*Upload File
HyperLink
*Upload File
Please see instructions at the top of this form for guidelines regarding file formats and file size etc.
PAYMENT DETAILS
Amount
*Enter The Amount
Cheque/Demand Draft No.
Date
*Enter Date
Bank
*Enter Bank Name
Branch
*Enter Branch Name
Payable at Delhi
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For Categories, entry fee, materials
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For help/clarification contact:
Kanupriya at
kanupriya@exchange4media.com
+91 9873106080