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Applicant Registration

All fields marked * are required.

Full Name *

Surname *

Residential Address *

Home Province *

Home District *

Mobile Number *

Enter a 10-digit mobile number (digits only).

Qualification *

Only B Pharm graduates qualify to apply.

High School *

School District

Email Address *

Password *

Min 6 chars, with uppercase, lowercase & a number.

Confirm Password *

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