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Drugwatch Sign Up Information

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Email Address


Your Name

 Full Name

Your Address

 Home Address, Zipcode

Phone Number


Post-Registration Data

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Membership Emails

Below is a sample of the emails you can expect to receive when signed up to Drugwatch.

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Request Type
Name (full)
Home address
Request Type
Please select a type:
Phone Number
Data Name Data Type Options
Request Type   Text Box
Name (full)   Text Box
Email   Text Box
Phone   Text Box
Home address   Text Box
Zipcode   Text Box
Request Type   dropdown Please select a type:
Phone Number   tel

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Comment by: admin
Comment on: 01/09/2020