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* 1. Please fill out the details below.

All personal information you provide will be used by the Western Bulldogs Football Club, AFL and on behalf of selected third parties in accordance with our Privacy Policy, this may include for promotional and direct marketing purposes and other disclosures as specified in our Privacy Policy found at http://www.westernbulldogs.com.au/privacy.

By providing your personal information, you agree to such use. Your personal information will be kept securely and confidentially.

Although you may choose not to provide us with certain information, please be aware that this choice will affect the type of and quality of service we can provide to you.

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