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On the
........................................................................................................(date)
I enclose a cheque for
..............................................................
Name
.........................................................................................................................................
Address
.....................................................................................................................................
Town
..........................................................................................................................................
County
.......................................................................................................................................
Postcode
...................................................................................................................................
Country
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Phone
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Email
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Please send your form & cheque to ....
Marilyn Allis, The Studio, Mill Lane Gallery,
9 Mill Lane, Wimborne, Dorset, BH21 1JQ
Tel (The Studio) : 01202 880084
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