Name *

First Name

Last Name

Phone *

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Address *

This is the address we will mail payment to for any sales or awards.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

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I confirm that I have read the Prospectus in full and agree to the terms within.

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I understand that my registration is not complete until I pay the registration fee.

*

I understand that registration fees are non-refundable.