New Account Setup

User Information

First Name

* Enter your first name

Last Name

* Enter your last name

Phone Number

Format: (123) 456-7890

E-mail Address

* * Enter your email address

Confirm E-mail Address

* * Re-enter your email address

Password

* Enter your password

Confirm Password

* * Re-enter your password

Group Information

If you are an internal staff member who will be submitting requests for either your group or department, please list as follows: WICSD-Dept or Group (First Name Last Name); example: WICSD-Business Office (John Smith)

Group Name

* Enter your group or organization name

Group Phone Number

* Format: (123) 456-7890

Street / Mailing Address

* Enter your group's street address

City

* Enter your group's city

State

- Please Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * Select your group's state

Zip Code

* Enter your group's zip code

Reason for Registration

* Explain why you're registering this group

Additional Group Information

External / Outside Groups: Upload the Group's Certificate of Insurance and its Expiration Date.

Upload your insurance certificate (PDF or JPG) *Please note that West Irondequoit CSD requires your Group to have a valid insurance certificate on file. Please upload a valid insurance certificate before continuing.

Expiration Date

Enter expiration date in MM/DD/YYYY format * Insurance file has expired

Additional Group Files