Kia mohio au ki to korero tuku i raro nei, na reira ka taea e matou te tuku i to tono ki te utu:
(1) Ingoa Kamupene / Ingoa________________
(2) Tel Number______________
(3) Wāhitau________________
(4) City_________
(5) State_____________
(6) whenua__________________
(7) ZIP Code________________
(8) Email________________