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REGISTRO DISCIPULADO
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NOMBRE
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APELLIDO
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TELEFONO
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EMAIL
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GENERO
MUJER
HOMBRE
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FECHA DE NACIMIENTO
MM
/
DD
/
YYYY
EDAD
18-25
26-35
35-50
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ESTADO CIVIL
SOLTERO
CASADO
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NECESITAS CUIDADO DE NINO?
No
Sí, DE 0 A 3
SI, DE 4 EN ADELANTE
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