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Motherland Connect
Step 1
First Name
Last Name
Email Address
Confirm Email
Phone number
Birthdate
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October
November
December
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Address
Username
Password
Confirm password
Gender
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Step 2
Do you have a passport?
Yes
I have applied for one
I will be applying for one soon
Passport Number
Passport Exp. date
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Do you have any Dietary Restrictions or Allergies?
NO
YES
Allergies Details?
Where would you call home?
Income Range
Less than $25,000
$25,000 to $34,999
$35,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 to $149,999
$150,000 to $199,999
$200,000 or more.
Which of the following best describes you?
Being early is on time, being on time is late
I believe in a 15 Minute grace period
I am no vacation! I left my watch at home
Would you be interested in a community service activity?
Yes! Sign me up
I would prefer to do something else
What are you looking to get out of your motherland experience?
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Step 3
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