Request Membership – Mosaic Mustangs

Account Details

Username (required)Email Address (required) Choose a Password (required)

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Hint: The password should be at least twelve characters long. To make it stronger, use upper and lower case letters, numbers, and symbols like ! " ? $ % ^ & ).

Profile Details

Name (required)

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Phone Number

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Who is allowed to see this field?

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Participating Children (Admin View Only) (required)

Please provide the first and last name, along with at least the month and year of birth, to help us maintain an up-to-date record of participating students and organize age-appropriate resources. This information can only be seen by the administrator. First Last - Month/Year

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Membership Agreement (required)

I agree to Membership Agreement.

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