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FLOWER LOVERS' CLUB - APPLICATION FORM
Name
Address
E mail
Telephone
Home
Office
Mobile
Date of Birth
Year
-- Select Year --
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
Month
-- Select Month --
January
February
March
April
May
June
July
August
September
October
November
December
Date
-- Select Date --
1
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Horticulture Crops Grown :
Are you growing horticultural crops as a hobby or commercial purpose :
Extent of Cultivation :
I hereby request the Membership of the club.
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