Christmas contest "Warmia"

Provide data to the registration receipt in contest Warmia

Receipt from the shop*:
Please Select Athlone Blanchardstown Mountview Bray Carlow Clondalkin Dundrum Mullingar Naas Navan New Ross Newry Portlaoise Sligo Swords Tallaght Belgard Square Tullamore WalkinstownBallymenaBlanchardstown CoolmineCavanCork BlackpoolCork Kinsale Cash & CarryFinglasFonthillGalway DoughiskaGalway Foodland DoughiskaGalway Tuam RdGalway WestsideGoreyLimerick Childers RdLimerick Park LodgeLurganMary StreetMoore StreetPolonez Belfast Boucher CrescentRailway St (Centre)RathminesTallaght Arena
Recipt number*:

Name*:

Surname*:

Date of birth*:

Address*:

City*:

County*:

Country*:

Phone*:

Email*:

Confirm e-mail*:

	I declare that I have read and accept the Terms and condition of the competition and I consent to the processing of my personal data by Polonez Group.
	I agree to the processing of my personal data by Polonez Group for marketing purposes.
	I agree that Polonez Group may send me information of promotions, special offers, discounts, new products etc which may be available from time to time in our stores.