Alaska's Professional Development Registry System

Registration Form
Please complete the requested information below. The fields with an asterisk (*) indicate required fields.
General Information
First Name* Middle Name Last Name*
Birth Date* (mm/dd/yyyy) Social Security Number* (last five digits) User Name*
Current Home Address
Street1* Street2
City* State* Zip*
County Region*:
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Country Code
Contact Information
Home Area Code* Home Phone* Email*
Alt Area Code Alt Phone
Other Information
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Alaska Training Registry Module Version: 3.5.2
Date: February 24, 2020 Release Notes