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* 1. Title

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* 2. First Name:

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* 3. Middle Name/s:

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* 4. Last Name:

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* 5. Gender

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* 6. Date of Birth:  (dd/mm/yyyy format):

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* 7. Contact Information:

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* 8. Whakapapa:

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* 9. Iwi Information

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* 10. Declaration:
I declare all the information contained on this registration form is true and correct.

I consent to the Tamanuhiri Tutu Poroporo Trust sharing my personal information with affiliated parties.

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