Part A: Personal Information |
| Note: Fields marked with * are mandatory |
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Email Address:
Please provide a valid email address if you would like confirmation when
your message is received |
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Part B: Postal Address for Response |
If you would like to provide an opportunity for Mr Barry Haase MP to respond,
please supply a postal address below |
| Address: | |
| Suburb/City: | |
| State or Territory: | |
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| Country: | |
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Part C: Your Message or Comment |
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