GSM-COMMUNITY
COPPA Registration Form
GSM-COMMUNITY

Please print this form, fill it in and either fax it to the number below or mail it to the provided mailing address.

Fax Number:
 
Mailing Address:
BLOCK E SHOP 50 ROBINSON PLAZA, WARRI. Deco

Account Information

Parent / Guardian Details

I understand that the information I have provided is truthful, that any information may be changed in the future by entering the supplied password and this user account can be removed by request.
Date: