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                    858 George Street, Dunedin

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                 RESERVATION   REQUEST   FORM

  Title :    Mr         Mrs        Dr        Miss

  First Name :

  Last Name :

  Address     :

  Phone (Hm)   :

  Phone (Bus)  :

  Phone (Mob) :

  Email Address :

  Select number of people staying :

  Enter Number of days staying :       

  Start date  :

  Special  Instructions :

   

                                                               

 

 

 

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