Stroud Evening WI

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* 1. First Name

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* 2. Surname

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* 3. Emergency Contact Name

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* 4. Emergency Contact Number

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* 5. Details of allergies or relevant medical information - to be be provided to emergency services only.

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* 6. I agree that the Stroud Evening WI can contact the above named person in caseo f an emergency whilst taking part in WI activities.

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