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Please print this page, fill in the form & fax it to: (0 312) 440 40 61 |
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MEMBERSHIP FORM
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Name |
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Surname |
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Birthday |
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Marriage Day |
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Wife’s or Husband’s Birthday |
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Job Title |
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Address |
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Telephone Business |
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Home |
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Mobile |
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Fax |
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Voice Information |
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Annual Wine |
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Consumption |
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Your Choice of Wine |
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Color |
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| [ ] Red | [ ] White | [ ] Rosé |