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* 1. First name

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* 2. Surname

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* 3. Email address

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* 4. Contact number

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* 5. Address

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* 6. Suburb

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* 7. State

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* 8. Postcode

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* 9. I wish to subscribe to NMFC communications and understand that my personal information will be collected and used in accordance with the AFL privacy policy, viewable at NMFC.com.au/privacy

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* 10. I wish to receive communication from Canterbury in accordance with its online privacy policy, viewable at canterburynz.com.au/company/online-help

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