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Last Name titles such as Jr, II, PhD
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Required if registrant is a minor
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If applicable
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Billing Address
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Apt./Suite or additional address details
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Enter 0 for non US addresses without State
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Enter zero for non US addresses without postal code
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Mailing Address
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*
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Apt./Suite or additional address details
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*
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*
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Enter 0 for non US addresses without State
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*
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Enter zero for non US addresses without postal code
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*
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Example: 555 345 2345 (numbers only)
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*
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*
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Want to sign up for updates and exclusive offers? Select all the methods desired to receive offers.
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*
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*
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*
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*
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AARP:
Members of AARP
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CCSU Alumni:
Alumnus of Central Connecticut State University
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CCSU Employee:
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CCSU GR Student:
Current CCSU Graduate Student
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CCSU UG Student:
Current CCSU Undergrade Student
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Military/Veteran:
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Standard:
All others
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For new accounts, add User Name and Password.
Password Requirements:
* From a minimum of 8 to a maximum of 15 characters - case sensitive
* Special characters allowed: !#$%&()*+,-./:;<=>?@[\]^_`{|}~
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Consent Statement
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