Submissions

Name of Organisation

Band / Group Name:

Name of Representative:

Nationality:

RSA ID or Passport Number:

Mobile Number:

Alternative Contact Number:

E-mail Address:

 
 
What is the status of your residency in the Eastern Cape?

I have a permanent address in the Eastern Cape.I am originally from the Eastern Cape but do currently not have a permanent address there.I am not from the Eastern Cape.

Please provide us with your physical address:

Address Line 1:

Address Line 2:

City / Town:

Postal Code:

Province:

Are you currently employed?:

YesNo

Company Name (if applicable):

Position (if applicable):

Biography (1 page, PDF or JPEG)

Youtube Link (Optional)

*Please note: All fields are compulsory
*No incomplete registration forms will be considered.

Name of Organisation

Location

Full Names

Publication Type
---PrintTelevisionRadioOnline

Role
---JournalistReporterPhotographerEditor

Primary Contact Number

Alternative Number: