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* 1. Full Name

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* 2. Are you a Current Registered Member of Caboolture Touch Association?

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* 3. Date of Birth

Date

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* 4. Contact Email

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* 5. Contact Phone Number

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* 6. Will you be at the Muster on 27th June?

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* 7. If you ARE NOT attending the Muster and would still like to be considered - Please submit reason for non attendance

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