Centre for e-Governance

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Salutation *	First / Given Name*	Middle name	Last / Surname


Gender *	Mobile No. *	E-mail *	Re-type E-mail*



Organization Address *
Address Line 1*		Address Line 2
Street address, P.O. box, company name, c/o		Apartment, suite , unit, building, floor, etc.

State *	City / Town *	Zip / Postal Code *



Organization Category *	Organization / Company / Institution *	Designation *



* Password must contain at least 1 Number, 1 Upper Case, 1 Lower Case letter, 1 Special character and password length should be minimum 8 and 15 maximum characters
Password *	Re-type Password *