Name

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* 1. Name

Email address
(Please note: we WILL NOT share your personal details (address and so on) with any third party.)

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* 2. Email address
(Please note: we WILL NOT share your personal details (address and so on) with any third party.)

Address (where disease seen):

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* 3. Address (where disease seen):

Postcode

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* 4. Postcode

Grid reference

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* 5. Grid reference

Host plant / Cultivar (if known)

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* 6. Host plant / Cultivar (if known)

Stage seen:

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* 7. Stage seen:

Date of observation:

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* 8. Date of observation:

Link to picture

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* 9. Link to picture

Additional notes

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* 10. Additional notes

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