| First Name: | $FORM{'fnameRN'} |
| Last Name: | $FORM{'lnameRN'} |
| Street Address1: | $FORM{'addr1RN'} |
| Street Address2: | $FORM{'addr2RN'} |
| City: | $FORM{'cityRN'} |
| State: | $FORM{'stRN'} |
| Zip: | $FORM{'zipRN'} |
| Email: | $FORM{'emailRN'} |
| UserID: | $FORM{'uidRN'} |
| Password: | $FORM{'pwd1RN'} |
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