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Name / Nom / Tinom

Nickname / Nom Lakaz

Last Name / Prenom / Sirnom

Email / Mel

Address

Address Line / Ladress

Lokalite

City / Lavil

Sponsoring NGO / ONG Sponsor

Device access / Laparey ki to servi

Device owner / Proprieter laparey

I Agree to the terms of service and privacy policy / Mo aksepte bann reg itilizasion ek kontra respe pou lavi prive

I Agree / Mo aksepte

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