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JEEP VICTORIAN POLO CLUB WEDNESDAY CHUKKAS NOMINATION FORM WEDNESDAY NIGHT AT WERRIBEE PARK NATIONAL EQUESTRIAN CENTRE Please ensure players read & complete all details below, including payment slip where necessary. Plea
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Document Date: 2014-01-07 19:03:37

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Company

MASTERCARD / /

Currency

USD / /

/

Facility

JEEP VICTORIAN POLO CLUB / /

Organization

Polo Club / VICTORIAN POLO CLUB / JEEP VICTORIAN POLO CLUB / /

Person

Amber Gibbs / Paul Roberts / /

/

Position

INDIVIDUAL PLAYER / financial member / /

ProvinceOrState

New Brunswick / /

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