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User Registration Form

*** To activate "Submit" button You have to confirm your LoginID by pressing "Check Availability" ***

 Provide Your General Information 
Name is a mandatory firld.
Please give the email address correctly.

* Name :
* Address Line 1 :
Address Line 2 :
* City/Town :
Pin :
* Contact No :  (Including STD Code eg. 03323579052)
Fax No : (Optional)
* E-Mail ID :


 Provide Your Subcription Type 
You have to give your Subscription Type.

* User Type :
* Subscription Type :


 Choose your LoginId and Password 

* Login ID :  
* Password :   (Password should contain atleast 6 alpha numeric characters with both upper case and lower case letters.)
* Re-type Password :


 
* FIELDS ARE MANDATORY
N.B. No special charecter (except @ , . / -) will be accepted as input.
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