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New User Registration
Title 1(Prefix):
First Name:		*
Middle Name:
Last Name:		*
Preferred Email:		*
Confirm Email:		*
Home Phone:
Country:		*
Address lines:		*
City:		*
State:		*
ZIP:		*
Maiden name:
Birth date:

Account Information
Username:		*
Password:		*
12 characters or more.
Confirm Password:		*
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4000 Lancaster DR NE

PO Box 14007

Salem, Oregon 97309

503.399.5148 | 503.365.4747

The Chemeketa Community College Foundation is a 501(c)(3) nonprofit organization.

Your gift is tax deductible to the extent allowed by law. Tax ID # 93-6097106