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Cornwall - Profile Registration

Billing Information

First Name

Last Name




Postal Code


Confirm Email

Billing Phone Number (including area code):

Age Range:


How did you hear about

Social Networking

Social Networking
  • From a friend / family
  • Newsletter
  • Facebook
  • Twitter
  • Stations in Ontario

  • 104.5 Fresh Radio
  • boom 101.9
  • Kingston
  • BIG 96.3 FM
  • Fresh 104.3
  • Ottawa
  • boom 99.7
  • Peterborough
  • 101.5 The Wolf
  • 100.5 Fresh Radio
  • Select the option that is most appropriate. If you use more than one of the stations listed, select the one you use MOST OFTEN.

    Default Shopping Region

    The default shopping region will be the region you will start in once you have logged in.

    It will also be the location you will pick up any orders that have not been shipped.


  • Cornwall
  • Kingston
  • Ottawa
  • Peterborough
  • If you wish to designate an alternate person to pickup up your certificates, enter their name below. The person listed will be able to pick up your certificate(s) on your behalf. In order to pick up your certificate(s), the person listed will need to have a copy of your confirmation email. Your alternate pickup name can be changed at any time by editing your profile.

    Alternate Pickup Name

    Shipping Information

    Use this area if you wish to save a default shipping address with your profile.

    Please note: You may change or remove the shipping address on a per order basis by using the appropriate buttons on the check out page.

    Payment Information

    Name on Card:

    Credit Card Type:

    Credit Card Number:

    Enter Number without spaces or dashes

    Credit Card CVD:

    What's this?

    Expiration Date:


    Please create a username and password for your profile

    Please make note of your username and password, you will need them to log in.
    Username and password must be entered exactly as you create them.


    Maximum 30 characters. Usernames cannot contain spaces.


    Must be between 5 and 12 characters

    Confirm Password

    Security Information

    As an extra measure in confirming your identity, please create a security question and answer.

    Please make note of your security question and answer, they will be used to verify your identity to edit your profile.
    Security answers must be entered exactly as you create them.

    Security Question

    Keep question to under 70 characters

    Security Answer

    Keep answer to under 70 characters

    Date of Birth


    / Month

    / Year

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