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SALSANEWS Member Registration

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User ID (max 30 chars)

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Mail (max 50 chars)

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Name (max 50 chars)

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Firstname (max 50 chars)

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Address (max 100 chars)

 
(max 100 chars)

 
Zip/Postal Code (max 10 chars)

 
Town (max 50 chars)

 
Country

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Password (max 20 chars)

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Confirm your password (max 20 chars)

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Datas quoted with ! are compulsory !