Account Application for University/College Affiliation

Complete ONLY if you are affiliated with a University or College. If you are affiliated with a Fire Department, click the browsers back button and choose FIRE DEPARTMENT AFFILIATION

Registration Details
User Name:

User Name needs to contain a minimum of 5 characters. Only letters, numbers, and underscores are allowed.
Password:

Password needs to contain a minimum of 7 characters. Only letters and numbers.
Confirm Password:  
Email:  
Confirm Email:  
First Name:  
Last Name:  
Job Title:  
College/University Affiliation:

Main location for this account
Address 1:  
Address 2:  
City/Town:  
State:  
Zip:  
Country:  
URL:  
Phone:  
Campuses you are responsible for:

IMPORTANT ... Type the City or Town where each of your campuses are located. Separate with a comma. These locations will appear as your personal "selection" list in the future when you are completing an incident report.
Are you a member of the Center for Campus Fire Safety? If not, click to visit our site and learn more: www.campusfiresafety.org
Have you attended our free Firewise Campus Instructor Training? If not, click to visit our site and learn more: www.firewisecampus.org
Would you like to receive our free monthly newsletter, Campus Firezone? To receive future newsletters click: www.campusfiresafety.org and sign up to be included in our mailing list. To download previous issues visit: www.campusfiresafety.org/CFZ.html
Affilation Logo Image must be a jpg file.
About Affilation  
 

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