Full Name:*
E-mail address:*
Please insert the email address you use most frequently.
College / University e-mail address:
This may be the same as e-mail address above. We need this to confirm that you are a full-time third level student.
Term-time address : *
Home address:*
Phone Numbers* These are required so that we can get in touch with you if there are delivery issues with a prize you have won. You must supply either a valid mobile or landline number but both would be preferable.
Mobile number:
Home phone number:
Gender:*
Male Female
Date of birth. *
1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st January February March April May June July August September October November December 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950
Which University / educational
establishment do you attend?*
Athlone Institute of Technology Cork Institute of Technology Dublin Business School Dublin City University Dublin Institute of Technology Dun Laoghaire Institute of Art, Design & Technology Dundalk Institute of Technology Galway-Mayo Institute of Technology Griffith College Institute of Technology, Carlow Institute of Technology, Blanchardstown Institute of Technology, Sligo Institute of Technology, Tallaght Institute of Technology, Tralee Letterkenny Institute of Technology Limerick Institute of Technology Mary Immaculate College National College of Art & Design National College of Ireland NUI Cork NUI Galway NUI Maynooth Royal College of Surgeons St. Angela's University College Dublin University of Dublin, Trinity College University of Limerick Waterford Institute of Technology Other
If Other please state University / educational
establishment you attend.
Course(s):*
When did you start your course?*
January February March April May June July August September October November December 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Please tick if you would like updates on new prizes, money-saving offers or opportunities in the following areas:
Password: *
Re-enter your Password:*
Favourite Place : *
To avoid missing out on prizes, please
remember to update your details if any of these should
change.
