AdsZens Pre Registration Form
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PERSONAL INFORMATION
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First Name *
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Middle Name *
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Last name *
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Birth Date *
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Month
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Day
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Year
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Gender *
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Country *
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Complete Address *
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Important: This is your mailing address. Used for sending products.
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Mobile Number *
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Phone Number *
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Email Address *
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Must be a valid EMail address
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Confirm Email *
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MEMBERSHIP
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AdsZens UserName *
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Alpha numeric only (A-Z and 0 - 9). Use comma to separate multiple user names.
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Alternative UserName *
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Sponsor Name
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Leave "Bert Quintana" on the field if you don't have sponsor.
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Sponsor Username
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Leave this field blank if you don't have sponsor.
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Placement Username
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Leave this field blank if you don't have sponsor.
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Placement Position
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Leave this field blank if you don't have sponsor.
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Product Package *
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For verfication, check the updated product package [click here]
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Other Package
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Fill-up this field only if you choose others on the Product Package field.
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OTHERS
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Facebook URL
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Notes
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FINALIZE
Please review the form to make sure that you have answered all fields correctly. Click the submit button if you're done.
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