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Name
*
Address line 1:
*
Address line 2:
Postcode:
*
Contact telephone number:
*
If this is not your number, who does it belong to?:
Email address (if any):
If this is not your email address, who does it belong to?:
Will you require transport to the Christmas party?
*
Yes (address line 1, postcode and contact number need to be compulsory if transport is needed)
No. I will make my on way
Do you have a wheelchair, or a walking Difficulty?
*
Yes. Please specify in comments box below
No.
Do you have a special diet?
Liquid
Caribbean
Diabetic
Other. Please specify in comments boxs below
Is there anything else that you think we should know?:
Where did you hear about us?:
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