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MALA REQUEST TO BE ADDED TO A MAILING LIST
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Email
*
Your email
Which Mailing list do you wish to join?
(
Note that Rockingham Branch of MALA has now been wound up, but residents are invited to participate at Peel or Perth
.)
*
PERTH
PEEL (Mandurah & district)
Required
Preferred title
Your answer
First Name
*
Your answer
LAST NAME
*
Your answer
POSTAL or STREET ADDRESS
Your answer
SUBURB & POSTCODE
Your answer
PHONE NUMBER
Mobile or landline - so we can contact you urgently in case of course changes or cancellations.
Your answer
HOW DID
YOU
HEAR ABOUT MALA?
Word of mouth
Radio
Newspaper
I picked up a flyer
Internet search
Saw it on a notice-board
Other (please tell us in comment below)
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MESSAGE
(Optional)
Your answer
Send me a copy of my responses.
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