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First Name | * | Email Address | * | ||
Last Name | * | All withdrawals will be made to the same name. | Please provide an active email address to facilitate future payment related correspondences, eg withdrawals, bonuses. | ||
Date of Birth | * | / / | Contact Number | * | |
Username | * | Please provide a valid contact number for future promotion and payment correspondences. | |||
Between 5 to 16 character only. | Preferred Currency | * | |||
Password | * | Between 8 to 10 character only. | Preferred Odds | * | |
Confirm Password | * | Affiliate | * | ||
Validation Code | * | 5519 | |||
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