Registration Form

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Registration Form

Kindly fill your information below:

Personal Information

Full Name: *

Firstname

M.I.

Lastname

Gender: * MaleFemale

Age:

Birthday: *

Address:

Nationality:

Religion:

Contact Number: *

E-mail Address: *

Friendster Profile:

Person to be contacted in case of emergency: *

Person Contact Number: *

Community Status

Are you a * Student?
Working?

Student

Level:

Grade/Year/Course:

School:

Working

Work Status:

Work Status: Trainee
Contractual
Regular

Position:

Company/Organization:

Office Number:

DDR Information

Level in Playing: Starter
Beginner
Intermediate
Mid-Level
Expert

Frequently Used Options: (check when on) Freeze Arrow
Boost
Reverse
Stealth
Dark
Hidden
Speed

1x1.5x2x

Favorite DDR Song:

Comments and Suggestions:

I hereby certify that the above information given are true and correct. *

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Created by: Christopher C. Lacastesantos; E-mail: potionchris at gmail dot com; Contact No.: 639082227101

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