Register form - Specialised Workshops
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  2. Member name(*)
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  3. Date of Birth(*)
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  4. Address(*)
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  5. Name of School(*)
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  6. Postcode(*)
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  7.  
  1. Primary Emergency Contact
  2. Name(*)
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  3. Relation to Member(*)
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  4. Contact Number(*)
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  5. Secondary Emergency Contact
  6. Name
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  7. Relation to Member
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  8. Contact Number
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  9. Name and Address of Family Doctor(*)
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  10. Surgery Phone Number(*)
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  11. Does your child suffer from any medical condition?(*)
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  12. If yes, please give details
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  13. (*)


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  14. (*)


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  15. I understand the pictures will be used for marketing purposes in local newspapers and on Menter Iaith Mon social networks.
  16.  
  1. Events(*)







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  2. Subtotal
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  3. Discount
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  4. Total
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  5. Payment Method(*)
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  6. Cheques should be made payable to Menter Môn and sent through the post to Menter Môn, Neuadd y Dref, Llangefni, Ynys Môn LL77 7LR.