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Udmeldelse af enkelt person
Questions marked by * are required.
1.	Navn: *
2.	Adresse: *
3.	Postnr.: *
4.	By: *
5.	Fødselsdato: *
6.	Email: *
7.	Telefonnr.:
8.	Mobilnr.:
9.	Lokalenr.: *
10.	Bandnavn
11.	Kontaktperson for lokalet: *
12.	Evt. bemærkninger