WPN Qualifier Kit Application
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Email *
Store Name: *
Primary Contact Name: *
Primary Contact Email: *
City: *
Province: *
Store Address: *
Shipping Address: *
Event Format: *
Preferred Event Date (Aug 1st - Sept 24th): *
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Are you a Premium Store? *
Store Website:
Which kit would you like to order? *
A copy of your responses will be emailed to the address you provided.
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