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First Name:
Last Name:
Birth date:
Phone :
House number:
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Ex member of band? -Yes No
If Yes, from
to (Year)
If not a member, what relationship or interest do you have
What Instrument did you play
and what did you Double on

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If No, which part(s) are not to be used - All or the following
Thank you for taking a few minutes to fill in this form. You will find a "Contact Us" box shown in the "Contents" list; we would be very pleased to hear from you; any anecdotes, stories, names of ex colleagues and friends you may want to find.