| |
|
Contact Details |
|
|
| Surname |
|
| First Name |
|
| Title |
|
| Country |
|
| Town |
|
| E-mail |
|
| Telephone Number |
|
| Mobile Telephone Number |
|
|
|
|
| What Countries do you Wish to Target? |
|
|
| Do you operate in the gaming sector at present?
|
Yes No |
|
Business Name
|
|
|
Website Address
|
|
|
Principle Business
|
|
|
Gaming License |
Yes
No
|
|
|
|
|
|
| Section 4 - Further Information
|
| Please give as many other details as possible
that you think are relevant (exposure to
the industry etc): |
|
|
| Would you like a brochure
mailed to you? |
Yes
No
|
|
| For a brochure, please provide your address if
different from the above address:
|
|
|
|
|
