Teachers please register below to enter this prize draw.

Closes end April 2012, winner contacted by phone in May 2012. Terms and conditions apply.

By providing your details below, we're able to provide you with a "no obligation" quote just before your insurance is due, leaving you free to decide if our quote is right for you. However if your insurance is already due, please contact us now and we'll enter you into the competition.

Applicable to teachers/educators, retired teachers and their partners providing the teacher/educator is insured with us. Subject to acceptance criteria, terms, conditions and minimum premiums.

Group*:
Title:
Surname*:		Motorcycle Renewal Date:
Forename*:
House Number/Name*:		Car Renewal Date: INTO & UTU:Proposers and male named drivers must be aged 23+, female named drivers 21+ AMiE:All drivers must be 30-69 inclusive
Postcode*:
		Home Renewal Date:
Address*:


Town*:
County*:
Date of Birth*:
Phone Number*:
Mobile Number:
E-mail Address:
How did you hear about us?		Please insert your reference number:

	I understand that by completing and submitting these details, the data will be held on computer and I agree that this information may be used by Adelaide Insurance to contact me in connection with my Car, Home or Motorcycle Insurance. Adelaide does not share your personal data with any other company or organisation. I agree *In order to provide you with an insurance quotation at the appropriate time, it will be helpful if you complete these sections. Note that this includes providing at least one insurance renewal date.