User Information
Prefix First Name* Middle Name
Last Name* Suffix Preferred First Name
Primary Title*
User Type
Primary E-mail* Alternate E-mail
Responsibilities 
Phone Information
Phone Type  Phone* 
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EXT
 
Address Information
Address Type  Address Address Line 2
City
Zip Code Zip+4
State 
 
Role Assignment
Secondary Title
Secondary E-mail
Organization*
Roles