| User Name: |
Enter your first and last name. The field is case-sensitive. This name will
also be used for mailing labels. |
| Title: |
Enter your position title. |
|
Full
Institutional Name: |
Select your institution from the drop down menu. If your institution is not
included on the list, send an e-mail to IDEhelp@sreb.org. Do not register using an institution name other than your own. |
| Address: |
Enter your mailing address. |
| City: |
Enter your mailing city. |
| State: |
Choose your mailing state. |
| ZIP Code: |
Enter your mailing address zip code. Use XXXXX-XXXX format. |
| E-mail: |
Enter your e-mail address. |
| Phone: |
Enter your telephone number. |
| Fax: |
Enter your fax number. |
| Password: |
Enter a password in this box. Passwords are case-sensitive. |
| Re-enter Password: |
Re-enter a password in this box. Passwords are case-sensitive. |
| Your Activity Role: |
In order to establish correct access codes for you, please select the description that best
describes your activity. |
| Listserv: |
Check the box to let us know you do NOT wish to receive listserv e-mail messages. |
General
Instructions: |
When you are finished filling out the form click, on Submit
to create your user account. Click on Reset if you want to clear the form
and start over. |
