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1. Name:

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2. Organisation (if any):

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3. Email address:

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4. Phone number:

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5. Age Bracket (as this is an intergenerational workshop we want to make sure that a good mix of ages attend)

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6. Do you have any special requirements e.g. dietary / mobility (if yes, please give details)

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7. Would you like to hear more about these kinds of projects / events and other Age Action news and events?

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