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EFTA01265810
yr I Ma de I Student is presently studying: [ ] Dance (type) 1,40 Music (instrument) VOICe :"Sc/prztric, p<1 Drama [ ] Sports (specify) Name of professional institution &its giL c Name of Instructor Mr C. Address 6 — CA-44...tOn Sc:t • we Sts1 City/state/zip New York / MI Y. 0 003 Telephone Length of attendan
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