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Connection to BURY
My family name is BURY.
One of my parents or grandparents, biological or adoptive, is a BURY.
My child, spouse or legally recognized partner is a BURY.
I received an invitation from a BURY Empire member.
Full name of this person or member
How are you related?
First name
Last name
Nickname
Date of birth
Country of birth
Nationality
Current profession
Email
REASON FOR YOUR REQUEST
Electronic signature
I understand that the information, discussions and activities I access in BURY Empire are intended for authorized members, and I agree to keep them confidential except when the law or the protection of a person requires otherwise.
I submit my application freely, in good faith and with good intentions.
I acknowledge and accept that admission to BURY Empire is a privilege granted by BURY Empire, not an entitlement.
Full name as signature
Date
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