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Please complete and print this form, and then send it with payment to :

Central Otago REAP
17A Brandon Street
Alexandra

I/We would like to apply for membership of Central Otago REAP Incorporated.

Name:

Contact person (if group):

Street/PO Box:

Town/Region:

Postcode:

 

 

Please find enclosed annual subscription of:

 

 

 

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