Banmines petition                 Date:        /        /                  Location (e.g. street/road/mall.) ........................................

 

 

Name
(printed and signed)

Address
(postal and/or email)

Your comment
(on landmines or on the petition)

Full name
(block caps):

Signature:

 

    

Full name
(block caps):

Signature:

 

    

Full name
(block caps):

Signature:

 

    

Full name
(block caps):

Signature:

 

    

Full name
(block caps):

Signature:

 

    

Full name
(block caps):

Signature:

 

    

Full name
(block caps):

Signature:

 

    

Full name
(block caps):

Signature:

 

    

Full name
(block caps):

Signature:

 

    

Full name
(block caps):

Signature:

 

    

Full name
(block caps):

Signature: