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First Name

Last Name

Street

Street 2

City

Zip/Postal Code

Country

Phone Number

Email

User Name (must be between 6 and 30 characters)

Password

Confirm Password

Your password must match the following requirements

Passwords must be at least 8 characters.
Passwords must have at least one uppercase ('A'-'Z').
Passwords must have at least one lowercase ('a'-'z').
Passwords must have at least one digit ('0'-'9').
Cannot contain the word "password"