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NEW MEMBER REGISTRATION FORM |
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Choose a password:
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Re-enter your Password: |
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Address Information |
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Title: |
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Name: |
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LastName: |
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Address1: |
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Address2: |
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ZipCode: |
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Country: |
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Phone:
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* For clients outside US/Canada, please write your phone number as follows:
(country code) + (area code) + (phone number)
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Fax: |
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Email: |
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(i.e.: youraccount@agivendomain.com)
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Date of Birth:
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Mobile Phone:
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Line Display |
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Promotions Type |
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Security Verification |
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Security Image:
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Type the characters you see in the image below:: |
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Residents of the states where local laws prohibit placing bets over the Internet are not accepted. By pressing the "Create Account" button, I accept Islandcasino.com's terms, conditions and rules as published on this site. I understand that Islandcasino.com is a foreign company and, as such, does not report the account activities, winnings or losses of its members to any government agencies. I hereby certify that I am at least 18 years of age and that I comply with the applicable laws in my jurisdiction with regard to placing a wager(s). I understand that all betting transactions take place on Islandcasino.com servers located in the country of Costa Rica.
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