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Resident Registration Form
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Name
*
First
Last
Username
*
Email
*
Password
*
Date of Birth
*
Gender
*
Male
Female
Civil Status
*
Single
Married
Widowed
Annulled
Separated
Address
*
Address Line 1
City
State / Province / Region
Number Gender Occupation
Contact Number
*
Occupation
*
Voter Status
*
Yes
No
Household ID (Household Number)
*
Submit
