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Become a DDIS User

* note as required field.
First name *
Last name *
User Group *   What's this?
IFAS Unit Name *
(enter N/A if not apply)
Address *
City *
State *   Zip *  
Country *
User ID *    
Password *  
Confirm password *  
Phone *
Fax
Cell # and provider

( )

Email *  
(your confirmation will be sent to this email address)
Are you a specialist? No  Yes
If yes, enter your
specialty and area.
Read Term of Use

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