P3 - Register

First Name:

The first name is required.

Last Name:

The last name is required.

Email:

The email field is required.

Username:

The username field is required.

Password:

The password field is required.

Confirm password:

*Note: The password must contain a minimum 8 characters at least 1 uppercase alphabet, 1 lowercase alphabet, 1 number and 1 special character.

Phone Number:

The phone number field is required.

Date of Birth:

Please Enter a valid date in the format (mm/dd/yyyy) enter valid date The date of birth field is required.

Provider:

The provider is required.

Register.