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Page 6 of 12 THE PHILIPPINE COLLEGE OF RADIOLOGY Exhibit Entry Form Cut this portion: Please complete form and submit with your Photograph entry/entries. Name ___________________________________________ Age: ___________ Sex ___________ Number of Photos: ______________ CD ________ (Note: Minimum size of Photographs 11”x14”. Label title at the back of each Photograph) Photo Title No.1. ____________________________ Photo Title No.2. ____________________________ Photo Title No.3. ____________________________ Telephone: _____________________ Fax: __________________________ Cell phone: _________________________________ Email address: ______________________________ Home Address: ______________________________ ___________________________________________ ________________________________________ Signature Date: _______________________
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