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First (Given) Name:
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Last (Family / Surname) Name:
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Email Address:
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Date of Birth: Month, Day and Year:
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Please Indicate Your Birth Country:
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UNKNOWN
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Username (CGFNS suggests using your email):
(6 - 50 characters long):
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Password:
(6 - 50 characters long):
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Re-type Password:
Please select a question you would like to be asked if you forget your Username or password:
-- Please select a Security Question --
What is your place of birth?
What is your favorite vacation spot?
What is your secret word?
What was the name of your first school?
What is your pet's name?
What is your mother's maiden name?
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Please select an answer to the security question:
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How did you hear about us?:
-- Please select a Referral --
ADVANCE for Nurses Magazine
American Journal of Nursing Magazine
Educational Institution
Employer
Friend/Relative
Immigration Attorney
Internet
Malayala Manorama
Manila Bulletin
Nursing Journal of India
Other
Philippine Inquirer
Philippine Star
Recruitment Agency
State Licensing Board
Times of India/Education Times
U.S. Consulate/Embassy
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