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Username	Required Username must not start with space Username must not end with space Username must not have two or more spaces in a row Username Suggestions
Password	Required Password needs to have at least 12 characters. Password needs to have at least one upper case character. Password needs to have at least one lower case character. Password needs to have at least one number. Password cannot be on a list of commonly-used passwords.
Confirm Password	Required Password needs to have at least 12 characters. Password needs to have at least one upper case character. Password needs to have at least one lower case character. Password needs to have at least one number. Password cannot be on a list of commonly-used passwords.
Salutation
First Name	Required
Middle Name
Last Name	Required
Legal First Name
Suffix
Pronouns
Address
Address line 1	Required
Address line 2
City	Required
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State / Province	  Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia ( Not Applicable or Other ) Aberdeenshire Anglesey Angus Antrim Argyllshire Armagh Avon Ayrshire Banffshire Bedfordshire Berkshire Berwickshire Blaenau Gwent Brecknockshire Bridgend Bristol Buckinghamshire Buteshire Caernarfonshire Caerphilly Caithness Cambridgeshire Cardiff Cardiganshire Carmarthenshire Ceredigion Cheshire Clackmannanshire Cleveland Conwy Cornwall Cromartyshire Cumberland Cumbria Denbighshire Derbyshire Devon Dorset Down Dumfries and Galloway Dunbartonshire Dundee Durham East Ayrshire East Dunbartonshire East Lothian East Renfrewshire East Sussex Edinburgh Essex Falkirk Fermanagh Fife Flintshire Glasgow Gloucestershire Greater Manchester Gwynedd Hampshire Herefordshire Hertfordshire Highland Huntingdonshire Inverclyde Inverness-shire Isle of Wight Kent Kincardineshire Kinross-shire Kirkcudbrightshire Lanarkshire Lancashire Leicestershire Lincolnshire London Londonderry Merioneth Merseyside Merthyr Tydfil Middlesex Midlothian Monmouthshire Montgomeryshire Morayshire Nairnshire Neath Port Talbot Newport Norfolk North Humberside North Lanarkshire North Yorkshire Northamptonshire Northumberland Nottinghamshire Orkney Oxfordshire Peeblesshire Pembrokeshire Perthshire Powys Radnorshire Renfrewshire Rhondda Cynon Taff Ross-shire Roxburghshire Rutland Scottish Borders Selkirkshire Shetland Shropshire Somerset South Ayrshire South Humberside South Lanarkshire South Yorkshire Staffordshire Stirlingshire Suffolk Surrey Sussex Sutherland Swansea Torfaen Tyne and Wear Tyrone Vale of Glamorgan Warwickshire West Dunbartonshire West Lothian West Midlands West Suffolk West Sussex West Yorkshire Western Isles Westmorland Wigtownshire Wiltshire Worcestershire Wrexham Yorkshire Antrim Armagh Carlow Cavan Clare Cork Derry Donegal Down Dublin 01 Dublin 02 Dublin 03 Dublin 04 Dublin 05 Dublin 06 Dublin 06W Dublin 07 Dublin 08 Dublin 09 Dublin 10 Dublin 11 Dublin 12 Dublin 13 Dublin 14 Dublin 15 Dublin 16 Dublin 17 Dublin 18 Dublin 20 Dublin 22 Dublin 24 Dublin County Fermanagh Galway Kerry Kildare Kilkenny Laois Leitrim Limerick Longford Louth Mayo Meath Monaghan Offaly Roscommon Sligo Tipperary Tyrone Waterford Westmeath Wexford Wicklow Aguascalientes Baja California Baja California Sur Campeche Chiapas Chihuahua Ciudad de México Coahuila Colima Durango Guanajuato Guerrero Hidalgo Jalisco Michoacán Morelos México Nayarit Nuevo León Oaxaca Puebla Querétaro Quintana Roo San Luis Potosí Sinaloa Sonora Tabasco Tamaulipas Tlaxcala Veracruz Yucatán Zacatecas Required
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Email Addresses
Email Address	Required
Secondary Email Address
Mobile Email
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Phone Numbers
Home Phone
Work Phone	X
Cell Phone
Phone Preference	Not Specified Home In Morning Home In Afternoon Home In Evening Home Any Time Work In Morning Work In Afternoon Work In Evening Work Any Time Cell Phone In Morning Cell Phone In Afternoon Cell Phone In Evening Cell Phone Any Time
Online Presence
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Misc Fields
Region	Not Specified English (Canada) English (USA) English (UK) English (Australia) English (New Zealand) Français (Canada) Español Português (Brasil) Português (Portugal)
Date of Birth	mm/dd/yyyy
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