Go to the cinema free for a year!

How to win
Simply register your details below and you could win a free cinema pass for a year! The Prize Draw will be held on 1st June 2012.

Eligibility
To enter you must be between the ages of 16 and 25, have taken a Chlamydia test this year (april 1st 2011 - march 31st 2012) and be resident in Birmingham and Solihull to apply.

How to register
Enter your details into the form below: 

Name
Sex	Male Female
Postcode	B1 B2 B3 B4 B5 B6 B7 B8 B9 B10 B11 B12 B13 B14 B15 B16 B17 B18 B19 B20 B21 B22 B23 B24 B25 B26 B27 B28 B29 B30 B31 B32 B33 B34 B35 B36 B37 B38 B39 B40 B41 B42 B43 B44 B45 B46 B47 B66 B67 B68 B72 B73 B76 B90 B91 B92
Date of Birth	D: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Mth: 1 2 3 4 5 6 7 8 9 10 11 12 Yr: 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 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 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903
Email Address
Mobile Number
When did you take your test?
Please fill in ALL above fields

All personal information submitted to BeSure is private and held in the strictist confidence, according to the requirements of the Data Protection Act 1998. By registering with BeSure you are agreeing to be contacted should you win one of our prizes. We may also contact you regarding future events and competitions.

Prizes
1st prize cinema pass worth £156 (2 winners will be drawn)
2nd prize ipod
3rd prize BeSure goodie bag!

• Winners must collect prizes from BeSure (Attwood Green Primary Care Centre, Bath Row, Birmingham, B15 1NZ)
• Winners may be asked to pose for photos
• Valid ID will be required to claim your prize