WORLD TRADE CENTER POZNAŃ sp. z o.o. ul. Bukowska 12 , 60-810 Poznań Person in charge: Jolanta Kanikowska Tel. 61/869 22 06, 61/866 59 36, fax: 61 866 61 34 e-mail: j.kanikowska@binte.pl , jolanta.kanikowska@wtcpoznan.pl Bank account: PEKAO S.A. IBAN PL 78 1240 6612 1111 0010 3433 8273 SWIFT: PKO PP LPW PIF GOLD MEDAL COMPETITION APPLICATION Tourist Product Applications’ deadline: 05.10. 2015 Exhibiting of a submitted device at the fair is the condition of the competition’s participation . Please, attach to your application materials facilitating product’s estimation. If exhibitor is not manufacturer of device submitted to the competition, it should attach relevant declaration or authorization of manufacturer. Transfer of the competition’s fee and enclosing the copy of the payment’s proof is the condition of participation. Company submitting product: Street: Telephone: Mailing code: Fax: Town/City: E-mail: Region: Internet: Exhibitor (full name): Pavilion, stand: Street: Telephone: Mailing code: Fax: Town/City: E-mail: Region: Internet: Entitled person in charge (first name, family name, post, telephone, fax): WE SUBMIT OUR PRODUCT TO THE COMPETITION (to be filled in separately for each submitted product) Fee for each submitted product 1900 PLN Tourist product’s name ( please, write full trade name ): - in Polish: ................................................................................................................................................................................... - in English: .............................................................................................................................................................................. Information about submitting company ( e.g. traditions, experience or others ) Description of the tourist product – according to the § 3, point 2 of the Competition’s regulations ( product’s core, real product, widened product ) Compact marketing information on a submitted product - max 500 signs with spaces: Also electronic version of this description ( e-mail or CD ). Owned attestations/ certificates/ testimonies/ results of research Received prizes or awards List of attachments ( CD presentation, product’s description, characteristic, photos, leaflets, catalogues, samples, drawings , product itself etc.): 1. ......................................................................................................................................................................................................... 2. ......................................................................................................................................................................................................... 3. ......................................................................................................................................................................................................... 4. ......................................................................................................................................................................................................... 5. ......................................................................................................................................................................................................... I declare that I know and approve competition’s Regulations. I confirm verity of information given on this form, I am also aware that submitting of any false information excludes participation at competition. I agree for using a photo of submitted product as well as a logo of ……………………………………...(please, write the name of a company ) for promotional aims of the Gold Medal Competition. Payer: full company’s name ( for invoicing ) _ _______________________________ Place and date ...................................................................................... .. .................................................................................... VAT No.: ............................................................................. _______________________________________ Company’s seal _________________________________ Legalny binding signature