   Welcome       Submission   
 
Registration
 
Register for our contest by filling out the form below. Registration is required for voting.
 
General Information
 
* First Name: 
 
* Last Name: 
 
* Birthday: 
   
 
* Gender: 
 Male      Female
 
* Public Name: 
 
  Must be 4-10 characters
 
* Email: 
 
  Only one registration is allowed per email address.
 
* Confirm Email: 
 
* Phone: 
 
  Will only be used to contact winners.
 
* Postal Code: 
 
* Your Nominee: 
 
Password Information
 
Passwords must be 8 to 20 characters.
 
* Password: 
 
* Confirm Password: 
 
Double check to make sure your information is correct and then hit submit below. Thank you for your participation.
By submitting the form you are confirming you are at least 19 years of age and have read and agree to our terms of service, privacy policy and rules.
 
 
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WTVY Silent Heroes of the Wiregrass

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