Demo
EM Registration


Welcome to online EM registration for Demo.

The registration process is as follows:
   1. Complete one form for each household. Fields with an (*) are required.
   2. If all the information is correct, click on the Submit button.

When all the required fields have been filled in, a password will be generated for you. The password can be changed, and you can request that the password be sent to you as long as you have entered the correct email address. A secure cookie will be stored on your PC so you do not have to log in to manage your information. If you submit a valid Email address, a confirmation message will be sent to you.
To select more than one option in a list, press the Ctrl key and click the left mouse button on each option.

Parent 1 / Head of Household

Title:    First Name *     Middle Name     Last Name *     Suffix     Nickname

Month of Birth *     Day of birth *

Home Address *     City *     State *     ZIP *

Enter None if you do not have an email address
Email address *

* At least one phone number is required.
Phone(s) - Home     Cell     Work

Activities: ()

Parent 1 mass preference: ()

Parent 1 EM Option:

Parent 2 / Spouse

Title:    First Name     Middle Name     Last Name     Suffix     Nickname

Month of Birth *     Day of birth *

Enter Same if same as above.
Home Address     City     State     ZIP

Enter None if you do not have an email address or Same if same as above.
Email address

* At least one phone number is required or enter Same if same as above.
Phone(s) - Home     Cell     Work

Activities: ()

Parent 2 mass preference: ()

Parent 2 EM Option:

Household Title Example Mr. & Mrs.
Emergency Contact Information: Name (first and last)     Phone

If you have any questions, please contact:
Contact Person
3010 Piccadilly Court, Garland, TX 75044
Phone/Fax: 972-244-4186    Email: some@where.com