ENTRY FORM
VINISUD FEBRUARY 15-17, 2016
I would like to present my award-winning wine(s):
1.  Tasting of your award-winning wine on February 15, 2016 from 2pm to 5pm: €320
2.  Collective Concours Mondial de Bruxelles stand from February 15 to 17 + tasting on
February 15 février from 2pm to 5pm: €1,850
COMPANY: …………………………………………………………………………………………………………………………………………………...……
ADDRESS: ………………………………………………..……………………………………………………………………………….…………………………
WEBSITE: ………………………………………………..……………………………………………………………………………….…………………………
TELEPHONE N°: …………………………………………………….. E-MAIL ADDRESS:………………………………………………………………
WINE NAME 1:
APPELLATION:
GRAPE VARIETY:
VINTAGE:
2015 MEDAL: Grand Gold  – Gold  – Silver 
TASTING NOTES:
BOTTLE SHOT OF THE AWARD-WINNING WINE TO BE SENT IN PDF
WINE NAME 2:
APPELLATION:
GRAPE VARIETY:
VINTAGE:
2015 MEDAL: Grand Gold  – Gold  – Silver 
TASTING NOTES:
BOTTLE SHOT OF THE AWARD-WINNING WINE TO BE SENT IN PDF
DETAILS OF THE COMPANY’S PROJECT CONTACT:
Surname:
First name:
Job title:
Mobile telephone number:
E-mail:
Financial contribution of €320 or €1,850 incl. VAT to be paid by :
 Bank transfer to VINOPRES SA IBAN: BE 87 0001 2552 7494 - BIC: BPOTBEB1
 Debit/credit card
(The amount is the same irrespective of the number of wines presented).
Name of card holder: …………………………………………………………………………………………………………………………….
Credit card number: ………………………………………………………………………………………………………………………………
Expiration date: ………………………………………….. Signature : …………………………………………………………………
Please send 4 bottles of your award-winning wine(s) to: Details of delivery to the show will be sent to
you at a later date
The wine(s) must be shipped before January 29, 2016