County of Rockland Training/Event Registration

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

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 *
Confirm Email *
Want to sign up for updates and exclusive offers? Select all the methods desired to receive offers.	Email Mail Phone

Resident
Volunteer Firefighter *

Membership Type *
	County Employee: County Employees
	County Resident: Non-employee : Agencies that operate within Rockland County
	Non-County Resident: Non Rockland County Agencies
	RCC Employee:
	Volunteer Firefighter: Rockland County Volunteer Firefighter - This group has access to Fire Training Center Firefighter training courses.

For new accounts, add User Name and Password. Password Requirements: * From a minimum of 8 to a maximum of 15 characters - case sensitive * At least 1 UPPER case character required * At least 1 lower case character required * At least 1 number character required * Special characters allowed: !#$%&()*+,-./:;<=>?@[\]^_`{\|}~
User Name (6-50 characters) *
New Password *
Confirm Password *

PROFILE CONSENT
I have read the consent statement: *	Yes Consent Statement