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Field

Data

Req

Description, Messages

First

*

example: Michael
Familiar

 

example: Mike, or what you like people to call you
Init

 

 
Last

*

 
Suffix

 

 
Email

*

 
Birthdate

 

format: m/d/yyyy
Occupation

 

 
Company

 

leave blank if this account is personal
Mail1

*

Your main street address
Mail2

 

Use only when necessary
City

*

 
State/Province

*

 
Zip/Postal Code

*

 
Country

*

 
Home Phone

**

Cell Phone

**

Work Phone

**

Fax

 

**At least one phone number is required
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The Center for Creative Learning
Conference Center:10919 W Bluemound Rd #50, Milwaukee, WI 53226
Map To Our Conference Center
Mail (only): 2437 N Booth St, Milwaukee, WI 53212
Office Phone: 414-374-5433
Conference Center Phone: 414-383-5433
Fax: 414-374-5433
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