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* 1. Name of artist

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* 2. Age of artist

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* 3. Name of parent or guardian (if artist is aged 16 or under)

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* 4. Email address

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* 5. Phone number

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* 6. Postcode

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* 7. Tell us about your connection to Peter Mac

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* 8. Tell us about your artwork

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* 9. What message would you like to send to patients and staff at Peter Mac during the festive season?

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* 10. Please upload your artwork here

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* 11. Declaration

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