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Basic Info

Organization Name

Required

Username

Required

Password

Required

	Has at Least 8 Characters
	Has at Least One Upper Case Character
	Has at Least One Lower Case Character
	Has at Least One Number

Confirm Password

Required

	Has at Least 8 Characters
	Has at Least One Upper Case Character
	Has at Least One Lower Case Character
	Has at Least One Number

First Name

Required

Last Name

Required

Address
Address line 1	Required
Address line 2
City	Required
Country	Required
State / Province	Required
Zip / Postal Code	Required

Contact Information
Email Address	Required
Work Phone	Required
Work Extension

Other
Website
Region
Time Zone	Required
Referral Email Address	Did an existing Better Impact member refer you to us? Please let us know their email so we can thank them!
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