Register - CLEDP

Basic Information

First Name

Last Name

Address*

Phone Number

City

State

Zip Code

E-mail Address

Username*

Password*

Confirm Password*

Your Physical Attributes

Birth Date

Weight

Height

Natural Hair Color

Natural Eye Color

Additional Information

Are you using birth control?

Do you smoke?

Do you have children?

What method of birth control do you use?

Have you been a donor before?

How many children do you have?

Occupation

Years of Education

College GPA

High School GPA

Required Questions

FDA regulations require that we ask you the following questions. Your complete honesty and accuracy are essential and appreciated. A "Yes" answer to any of the following questions will not necessarily disqualify you.

Only fill in if you are not human

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