Northwestern University Center for Public Safety

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Please create a client profile for yourself. You will then be able to submit a registration.

To submit a registration for someone other than yourself, once you have created your account, click on My Account, click on Manage Members, then click on Add a New Member.

Add a member account for each person for whom you wish to register.

Please enter the profile information for the person attending
the course/conference/camp/product.

* denotes a required field

Name Prefix
First Name *
Middle Name/Initial
Last Name *
Name Suffix	Last Name titles such as Jr, II, PhD
Affiliated Company/Employer	If applicable
Department	Provide Department if you did not find your "Company \| Department" above.

Mailing Address
Address 1 *
Address 2	Apt./Suite or additional address details
City/Town *
State/Province *	Enter 0 for non US addresses without State
Postal Code *	Enter zero for non US addresses without postal code
Country *

	Example: 555 345 2345 (numbers only)
Home Phone
Work Phone
Mobile Phone
Fax Phone
Email Address *
Secondary Email Address
What is the best way to reach you regarding your registration(s)? Please select all that apply.	Email Mail Phone Fax

Birth Date (mm/dd/yyyy)
Gender

For new accounts, add User Name and Password. Password Requirements: * From a minimum of 8 to a maximum of 15 characters - case sensitive * Special characters allowed: !#$%&()*+,-./:;<=>?@[\]^_`{\|}~
User Name (6-50 characters) *
New Password *
Confirm Password *

PROFILE CONSENT
Do you give consent for us to record your personal data for the lawful purpose of providing and managing an educational service? *	Yes Consent Statement