Account Registration – Comox Valley community way by Pieter Vorster | Apr 23, 2013 | Client News | 0 comments Please enter your desired username. * Choose your username with some care as it will be used frequently. Use only letters and numbers, with no embedded spaces or #&$!@ etc. Please enter an alternative username In case your first choice is unavailable First Name (or Organisation name) * Last Name (or Organisation contact) * Email address * Confirm email address * Phone * Mobile Street address or P.O. Box number * City * Postal Code * Website (if applicable) If you have recently made a contribution to a non-profit in exchange for cw$ please enter the amount of your contribution below. Note: cw$cannot be credited to your account until corroborated by your payment receipt. If you entered an amount above, please specify the name of the organisation from whom you purchased your cw$. Never submit passwords through Google Forms. Submit a CommentYour email address will not be published. Required fields are marked *Comment * Name * Email * Website
