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Data Name	Data Type	Options
Join our mailing lists	Text Box
First name	Text Box
Last name	Text Box
Username	Text Box
Password	Text Box
Email	Text Box
Home address	Text Box
City	Text Box
State	Text Box
Country	Text Box
Postcode	Text Box
Password (confirm)	Text Box
* Phone	tel
* Country	dropdown	United States of America
* State	dropdown	United States of America
	checklist	Join our mailing lists