rosie's postcard address collection form

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rosie's postcard address collection form

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* Indicates required question

Email *

Your email

have you filled out this form before?

Yes

No

Clear selection

if YES, did your address change?

N/A

My address changed

My address is the same

Clear selection

Name *

Your answer

Address line 1

Your answer

Address line 2 (apt/unit)

Your answer

City

Your answer

State

Your answer

Zip Code

Your answer

Country

Your answer

...this form has been getting a lot of funny internet spam. could you put title of a song or album of mine in this box? *

Your answer

Anything else you need to communicate! // Also if you want me to take you off the postcard list lemme know!

Your answer

Submit

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