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• Name

• Username*
• First Name
• Last Name

• Contact Info

• E-mail*
• Phone Required phone number format: (###) ###-####
  Used for contacting you in terms of winning a contest.

• About Yourself

• Profile picture

• Biographical Info
• Password*
• Repeat Password*
• I allow the website to collect and store the data I submit through this form.*

• Send these credentials via email.