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New User Registration

* First Name:

* Last Name:

Preferred Badge First Name:

Work Information

* Organization Type:

(start typing the name to locate your organization in the list)

MN Public School

My Public School is not listed above. I want to enter my Public School.

* Public School Name:

* Address Line 1:

Address Line 2:

* City:

* State/Country:

For United States and Canada:

* Zip:

MN Public Charter School

My Public Charter School is not listed above. I want to enter my Public Charter School.

* Public Charter School:

* Address Line 1:

Address Line 2:

* City:

* State:

For United States and Canada:

* Zip:

MN Private School

My Private School is not listed above. I want to enter my Private School.

* Private School:

* Address Line 1:

Address Line 2:

* City:

* State:

For United States and Canada:

* Zip:

Agency/Other

My Organization is not listed above. I want to enter my Organization.

* Organization Name:

* Address Line 1:

Address Line 2:

* City:

* State/Country:

For United States and Canada:

* Zip:

Individual

* Email:

* This will be your login ID

* Confirm Email:

* Password:

(must be at least 6 characters long)

* Confirm Password:

* Position / Title:

* Phone Number:

Ext.

Fax Number:

* Do you Require Special Accommodations?

	Yes * Please tell us about your Special Accommodations:
	No

Home Information

Home Address:

Home City:

Home State/Country:

For United States and Canada:

Home Zip:

Home Phone:

Cell Phone:

Home Email: