Brandon University - Public Access

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Step 2. Activate Account

Step 3. Account Activated

Contact Information Note: Red text indicates required fields.

Billing First Name:

Billing Last Name:

Address 1:

Address 2:

Country:

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Phone 1:

Phone 2:

Fax:

Email:

Alternate Email:

Client #:

Account Information

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Password:

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Extra Information

Sex At Birth:

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Medical Information

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Allergies:

Yes

Other Medical Conditions:

Yes

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