My name |
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My address |
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Town/City |
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Country |
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Postcode/Zip Code |
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Daytime telephone no |
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Email address |
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I would like to nominate the following person to be considered for a Grant by the Board of Trustees of the Line Dance Foundation. |
Please note that all details of beneficiaries and grants are kept in total confidence, unless beneficiaries agree to details being released. |
Full name of nominee |
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Nominees telephone no |
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Nominees Email address |
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Nominee's
postal address |
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Town/City |
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Postcode/Zip Code |
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Country |
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Details of the nominee's
Line dance background |
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Please provide a reason (or reasons)
for the application |
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Digital signature
(please insert your initials) |
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Date |
[DD/MM/YYYY] |
To prevent spam enter 8532 in the next box |
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