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User Information
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Choose Account Name:
Choose Password:
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First
Name
Last
Name
Address 1:
Address 2:
City:
State:
Zip/Postal Code:
Country:
Phone:
Fax:
E-mail:
Birth Date: Month
Day Year
Your Gender:
Your Education:
Your Annual Household
Income:
I would use the Internet
to purchase the following items:
CO NAKUPUJETE NA INTERNETU:
Apparel
Automobile
Computers & Accessories
Credit Cards
Electronics
Insurance (any type)
Magazines/Books
My Favorite CDs
Office Eqpmnt & Supplies
Stocks
Reservations (Air/Car/Hotel)
Never Purchased Online
Other, please specify:
I use the Internet to
find information on:
NA CO POUŽÍVÁTE INTERNET:
Business News
Computer Games
Computer Programming
Current Events
Email friends and family
Employment
Entertainment Gossip
Health, Fitness, Exercise
Parenting
Research
Sports
Special Offers & Coupons
Stock Information
Travel/Vacations
Weather
Women's Issues
Work Related Reasons
Other, Please Specify:
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to fill out the above sections in order for your registration
process to be completed.