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"Registration Form B"

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Registration Form

Please fill out the fields below to Register & Win a Free Digital Diary(128 KB memory) from Casio. Press the Submit button at the end of the form when done.

Your Name:

Your Phone Number:

Dont forget to enter Area code in Phone No.

You are Male/Female:

Your Age:

E-mail address:

Mailing address:

City, State, Zip:

Or you can mail the above requirements at "pakistanbrainbank@yahoo.com" to Win. If We found that the information is false then your name will be Removed from the Contest and be sure your mailing address will be correct so that the prize would be send at the right place
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