Associate Member Registration

Membership Form
Date
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Username
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First Name
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Last Name
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Password
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Please enter at least 6 characters.
    Strength: Very Weak
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    Phone No.
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    Please enter at least 11 characters.
    Maximum 11 characters allowed.
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    *
    Email Address
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    City of Residence
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    Current Professional Status
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    Company / Institution
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    Website
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    Please enter valid website URL.
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    How many hours can you volunteer every month to OPEN Toronto Chapter?
    Select2-4 Hours5-7 HoursMore
    Please select atleast one option.
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    Main Skills and Professional strengths which can be shared with other members
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    Professional Highlights/Achievements
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    Why you would like to join OPEN Toronto Chapter?
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    Do you know any OPEN member? Please provide name
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    Profile Photo
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    Select Your Payment Gateway
    Transfer your payment to the following bank account.
    Bank Name
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    Account Holder Name
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    How you want to pay?
    Payment Summary

    Your currently selected plan : , Plan Amount :
    Coupon Discount Amount : , Final Payable Amount:
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