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                REGISTRATION FORM

    Last Name                     

    

    First Name                     

    

    Middle Name                  

    

    Registered Business                             Name 1) 

    

                                      2)  

    

   Type of Business       Ownership                   

    

   Capitalization                  

    

   Current Address             

    

  State                  

    

   Country                           

    

   Business Address           

    

   Home Number                 

      

   Office Number                 

      

   E-mail Address                

    

   URL

    

   Nature of Business          

 Major Activity

 

 Minor Activity

  Principal Products            

   

  Minor Products                 

   

  Number of Employees

   

  Target Market                  

   

  Age Group                       

    

  Remarks                          

    

  Action                               

             

(Note: All Fields in WHITE are required.)

 

 

 
 

 

 
Clubwww1 is a Division of Service on Sight Research & Consultancy Inc.
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