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Important Notice

 

Please be advised, if you are currently employed at a PA liquor licensed establishment, you will need to enter the license identification number (LID), during registration. The LID number can be found on the establishment’s liquor license.  By providing this important number, your establishment will receive credit for you participation.

Required items are marked with an asterisk (*).

Name:
*First Name:
Middle Name:
*Last Name:
*Email:
*Username:
  • Must be at least 6 characters and no more than 25 characters.
  • Cannot contain 'admin' or 'administrator'.
*Password:
  • Must be at least 6 characters and no more than 25 characters.
  • Cannot contain 'password', '123456', '654321' or contain the username.
Confirm by entering again:
LID (numeric only):
Address:
*Street Address:
*City:
*State/Province:
*Postal Code:
*Country:
Phone Number(s):
*Phone Number:
Job Title:
*Last 4 digits of SSN:
*Date of Birth:
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