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Date
Firstname
Surname
Tel. No. (Home)
Tel. No. (Office)
Postal Address
Post code
Email address
Have you ever been a member of Lions Clubs International before?
	Yes No
If yes, which Club?
How did you hear about Lions Clubs International?
	A friend A relative An existing member Leaflet through door A poster A Lions event The TV The radio A newspaper A magazine Browsing the Internet
Other (please specify)