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- "שם פרטי" is a required field.
- "שם משפחה" is a required field.
- "ת.ז. (9 ספרות)" is a required field.
- "מין" is a required field.
- "שנת לידה" is a required field.
- "עיר מגורים" is a required field.
- "נייד" is a required field.
- "השכלה" is a required field.
- "דוא"ל" is a required field.
- "שם החברה/ארגון" is a required field.
- "תפקיד נוכחי" is a required field.
- "נסיון ניהולי בשנים" is a required field.
- "בוגר אוני ת"א" is a required field.
- "בוגר להב" is a required field.
- "הצהרת עמית" is a required field.
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