UEA Registration via Mailchimp
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Name:
Email:
Comment:
Email Address
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First Name
Last Name
Resident 2 Email Address
Resident 2 First Name
Resident 2 Last Name
Upper East Street Number (e.g. 321)
Upper East Street Name (e.g. E Mission St)
Unit #, if any (e.g. 4, or B)
Upper East Zip Code (5 digits)
Mailing Address Line 1 (if different from above)
Mailing Address Line 2 (City, State, Zip)
Preferred Phone Number
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