Name
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Address
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Telephone
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E-Mail --------------------------------------------------
Date --------------------------------------------------
Course date (please indicate preferred date)
Price £150.00 Per Person
payment to, X-Calibre Ltd please.
To D Mills ATEO 83 Princess St, Chase Terrace, Burntwood, Staffs, WS7 8JN
For office use only
Payment Sent £_____ Cheque No_____________
[ ] Rifle for pest control
[ ] Pistol for pest control
[ ] Pest control operative
Date of receipt_____________
Registration no_____________
The personal information supplied will be used for contact purpose and not stored in any form to compile to The Data Protection Act 1998.
