Last Name: | Smith |
First Name: | Daniel |
Gender: | Male |
Street Address: | 343 Maple Lane |
City: | Stafford |
State: | Houston |
Postal Code: | 23235 |
Phone Number: | 55555555 |
E-mail Address: | dsmith@mail.com |
Birth Date: | 1990/04/05 |
First Language: | English |
Course Name: | Travel and Tourism (Select from the drop down list) |
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