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The Rep College
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Name of Candidate: |
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Address: |
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Telephone Number: |
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Date of Birth: |
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Nationality: |
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Name of Next of Kin: |
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Address of Next of Kin: |
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I should like to join the ___________________ course
during ___________________ (month) ___________________ (year).
Signed _________________________________
Date ___________________________________
(Applicants must be aged 18 or over on leaving the course)