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On-Line Registry Form
If You Are:
1. member of
CCOREm
2.
member of a professional association
3. a social/community organization representative
4.
faculty member
5. government representative
6.
private sector representative
Please Fill in
the Form Below
(to register properly, please
press both SUBMIT
buttons
below)
Representative's name, Title and Organization
*
It's required to provide this information
Phone Number
*
It's required to provide this information
Email
*
It's required to provide this information
Number of additional guests
*
One
Two
Three or more
Can you make it?
*
Yes
No
Maybe
It's required to provide this information
Submit
While this
field is optional
,
we encourage
you to provide us
the following information
How did you hear about this site?
*
Internet Search
Advertisement
Friend
Other
This information is optional
If Other please specify:
*
Submit
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Copyright 2017 -
e
-Depot Corp
®
.
& the
e
-D.C.i
Student Chapter @ UPRM
,
ALL RIGHTS RESERVED