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First Name* Including middle name and initial as it appears on the OneCard.
Surname*  
Date of Birth*

Group*

Certificate #*
* indicates required information
Note: Group, certificate numbers and names must be entered as they appear on your RWAM OneCard, if applicable.
Do not include the "RAM" prefix, or the dash/digits suffix if these appear in your certificate number. E.g. RAM123456789012-00