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| Your Name(s): |
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John & Mary Citizen |
| Address: |
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432 Hunter Street Address for mailing purposes |
| City: |
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NEWCASTLE City for mailing purposes |
| State: |
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NSW State for mailing purposes |
| Post Code: |
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2300 Post Code for mailing purposes |
| Postcode of Exchange home: |
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If different from mailing address postcode |
| Telephone: |
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02 1234 5678 - one number only |
| Fax: |
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02 9876 5432 - one number only |
| Email: |
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me@home.com - one address only |
| URL: |
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www.yourDomain.com - personal web site |
| Occupation: |
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physician/teacher - you & your spouse |
| Family Size: |
Adults
|
Teens
|
Children
|
Adults-Teens-Children
2 - 1 - 1 |
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| Location: |
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Please enter nearest major city or town, distance home is
away and direction from major city or town TO your home.
Sydney 100k, S = home is 100 kilometers south of
Sydney.
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| Dates: |
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Please use one of the following formats, precisely:
3w, Anytime; OR 7d-3w, 1 Jul-30 Aug |