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Appeal Form

Please complete this form with details of your appeal
Alternatively, post the information or Email Radio Jackie's Info desk at [email protected]

Organisation:
Looking for: 
Purpose:
Address: 
Post town:
County:
Postcode:
Start date (DD/MM/YY):
End date (DD/MM/YY):
Day / Date Text:
ie: On Monday 1st January, Monday 1st to Friday 4th January, Every Monday throughout January.
Times (if applicable): 
Cause, if proceeds going to charity: 
Contact details to appear on listings / advert:
Contact name: 
Telephone number:
Email address:
Website:
Additional details (Maximum 255 letters /  spaces / characters per line. Form will reject if over):
For Office Use (Not For Broadcast)
Are you a registered charity, or raising funds for a registered charity:           
Contact name for queries (if different from above):        
Telephone number for queries (if different from above):
Email address for queries (if different from above):       

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