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* Required Field

Please complete the following to continue.
* First Name:
* Last Name:
* Email Address:
*Address Line 1:
Address Line 2:
*Affiliate: Proctor Examination Administration
*University Name
* Passwords must contain both upper and lower case letters
* Passwords must contain alpha and numeric characters
* Passwords cannot have three or more consecutive same characters
* Passwords must be 8 - 20 characters
* Passwords cannot have leading or trailing spaces
* Passwords cannot be the same as the Username, User ID, or email address.

Your email address will serve as your user name.  Please ensure you have entered the correct email address.