USERNAME *
Spaces are allowed; punctuation is not allowed except for periods, hyphens,
apostrophes and underscores.

E-MAIL ADDRESS *
A valid e-mail address. All e-mails from the system will be sent to this address.
The e-mail address is not made public and will only be used if you wish to
receive a new password or wish to receive certain news or notifications by e-mail.

PASSWORD *

CONFIRM PASSWORD *

FIRST NAME *

LAST NAME *

MIDDLE NAME

ADDRESS LINE 1 *

ADDRESS LINE 2

CITY *

STATE *
Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Minor Outlying Islands Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

ZIP *

DATE OF BIRTH (mm/dd/yyyy) *

PRIMARY PHONE xxx-xxx-xxxx *

CELL PHONE xxx-xxx-xxxx

EMERGENCY CONTACT PERSON *

EMERGENCY PHONE xxx-xxx-xxxx *

TERMS AND CONDITIONS * I have read and agree to the CMC Code of Conduct
Please read and agree to our Code of Conduct.

Acknowledgement of Risk and Release of Liability * I have read and agree to the Risk and Release of Liability
By Checking here, you are consenting to the use of the checkbox in lieu of an original signature on paper. You are agreeing to enter into this electronic contract with this electronic signature and you are accepting the terms of this electronic Acknowledgement of Risk and Release of Liability. You acknowledge that you may download and save or print this electronic contract. After checking here as your electronic signature, you may, upon written request to us, obtain a paper copy of this electronic contract. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic checkbox for your signature on any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic checkbox. You should always make sure that we have your current email address in order to contact you regarding any changes, if necessary. Click here to view the form

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