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Registration form 23-36 (June 6th)

Please complete this form to register for the next event. You will be contacted for payment once your form has been reviewed. All information/pictures will remain confidential and will not be shared, unless given permission. Once you have submitted the form, you will be entered into 5 Minute Coffee Date's database to be considered for matchmaking opportunities. 

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Address: 123 Main St. Anytown, USA 12345

Tel: 555-555-5555

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