Exhibitor details Exhibitor Have you entered the Shiraz Challenge before? Yes No Winery name Company name Entry coordinator - First name Entry coordinator - Surname Phone number(area code must be included) Mobile number Email address Postal Address Address Suburb/Town/Locality Postcode State ACTNSWNTQLDSATASVICWA Payment Payment details Payment method Credit CardChequeDirect Deposit Card type MastercardVisa Card number Expiry date(mm/yy) 010203040506070809101112 / 2425262728293031323334 Name on card Entry details Leave unused entries blank. Entry Details Entry Number 1 Wine class StillSparklingOrganic Vintage (4 digit year) [Enter 1111 if non-vintage] Wine name (as labelled) RRP $ Region Alcohol/Volume % Closure (select from the list or enter your own) CorkScrew capSynthetic corkOther Availability Cellar door; and/or Mail order; and/or Retail, if so what outlet(s) Retail outlets Entry Number 2 Wine class StillSparklingOrganic Vintage (4 digit year) [Enter 1111 if non-vintage] Wine name (as labelled) RRP $ Region Alcohol/Volume % Closure (select from the list or enter your own) CorkScrew capSynthetic corkOther Availability Cellar door; and/or Mail order; and/or Retail, if so what outlet(s) Retail outlets Entry Number 3 Wine class StillSparklingOrganic Vintage (4 digit year) [Enter 1111 if non-vintage] Wine name (as labelled) RRP $ Region Alcohol/Volume % Closure (select from the list or enter your own) CorkScrew capSynthetic corkOther Availability Cellar door; and/or Mail order; and/or Retail, if so what outlet(s) Retail outlets If you would like to enter more than three wines please enter here the total number of wines you would like to enter: After entering the total number, click on the submit button. The form will display again with more entry spaces, rather than being checked and processed. Declaration There is no confirmation step, so please check your form to make sure your information is complete and correct. If there are any errors you will be asked to correct them. Please ensure this information is correct as this will appear on any trophies, publications and correspondence. Entry declaration: I declare I have read and understand the entire Contents of the Document including the Conditions of Entry Regulations and Entry Criteria and agree to be bound by them and abide by all decisions made by The Great Shiraz Challenge Pty Ltd. Full name of person signing form Position
