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Participant First Name * | |
Participant Last Name * | |
Participant Email * | |
Participant Company | |
Participant Phone 1 * | |
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Name on Card (if different) | |
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Street Address 1 * |
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Street Address 2 |
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City * |
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State * |
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Postal Code * |
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Country | |
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Card Type * | |
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Card Number * |
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Expiration Month * | |
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Expiration Year * | |
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CVC * |
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By entering your initials and registering for this
course, you acknowledge that your spoken questions or public comments during the course may be recorded, copied,
transcribed, and distributed by The Shift Network and consent in advance
to these uses.
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I have read and understand the terms of this agreement. |
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(Enter your initials) |
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