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Welcome to College of the Mainland! Please complete the following information to build your profile so you can register for classes or activities.

* denotes required information.

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Username*

Username: minimum 6 characters

Password*

Password: minimum 12 characters, must contain a number and any two of the following three: upper case, lower case, special characters (for example: (){}!@$%^&*)

Password Strength

Re-enter password*

Password hint*

Identity Verification Question*

Identity Verification Answer*

E-mail*

Re-enter E-mail*

First name*

Middle Name

Last name*

50 Plus

Yes No
Are you 50 years of age or older?

Birthdate *

Social Security Number

Phone*

Additional phone

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Mail preference

May we include you on our mailing lists?

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Primary Address

Primary Address Type*

Country*

line 1 > Address*

line 2 > Address

City*

State*

Province *

Zip*

Zip+4

Secondary Address

Same as Primary Address

Secondary Address Type

Country

line 1 > Address

line 2 > Address

City

State

Province

Zip

Zip+4

County *

County of residence

Country *

Country of residence.

Gender *

Female Male

Ethnicity *

Hispanic or Latino origin is a person of Cuban, Mexian, Puerto Rican, South or Central American, or

Race *

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How you heard about us

Colleague ID

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