New Listener - Bournemouth and Wessex Talking Newspaper

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New Listener Form
Questions marked by * are required.
1. Name: *
2. Address *
3. Post Code *
4. Telephone Number
5. Would you like Tape , CD or Memory Stick? *
  • Cassette Tape
  • C.D.
  • Memory Stick
6. Email:
7. Registerd Blind or Partially Sighted? *
  • Yes
  • No
8. Age Range (Optional, but it helps us plan our programs.)
  • Under 40
  • 40-50
  • 50-60
  • 60-70
  • over 70
9. Message:
 
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