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  1. Carers Rights Day collections

    Please complete this form to express your interest in joining us at a Carers Rights Day collection to help raise money for Carers UK.

  2. Name(*)
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  3. I'd like to collect at:(*)

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  4. Address 1(*)
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  5. Address 2
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  6. Address 3
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  7. Town(*)
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  8. Postcode(*)
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  9. Email address(*)
    Please enter a valid email address.
  10. Contact phone number
    Please enter a valid phone number.
  11. T-shirt size
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  12. How did you hear about the collections?(*)
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  13. If 'other', please provide details here:
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