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* 1. ORGANISATION NAME: .

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* 2. YOUR NAME

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* 4. TELEPHONE NUMBER:

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* 5. EVENT START DATE & END DATE

Date
Date

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* 6. EVENT START TIME / END TIME

Time
Time

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* 7. PROPOSED EVENT:
1 ) Please provide as much information about the activity as possible to help us to understand your requirements.

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* 8. IS THIS A REGULAR EVENT?

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* 9. PROPOSED EVENT / ACTIVITY :

WHICH SPACE/S DO YOU REQUIRE?
(details of spaces are on www.stmattsbrixton.org)

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