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BracketContest.com Registration

Fill in and submit the following form to enter the contest. Only one entry per person is allowed. Multiple entries by the same individual will disqualify that participant from receiving any prizes.

All fields are required unless noted

Player Registration
First Name:
Last Name:
Choose Username:
Choose Password:
Confirm Password:

Contact Information
Email:
Confirm Email:

Please make sure to enter a valid and active E-mail Account. This will be used as the primary method of contact, as well as the only way to obtain a new password in the case that you lose or forget the one you have selected.
Address Line:
City:
State:
Country:
Zip: (Required for USA, AU, and CAN)

Submit the Form
Please enter the number you see in the image to the right in the field below it. Authentication Code
Authentication Code: