New Account

Create New Account

Please provide the following information for the participant you are registering. If you are registering someone other than yourself, please enter their information below and click the Submit button to create a new account.

Personal Information

ID #:	NEW-ACCT:
Source:
Password:	Your password can be up to 10 characters (no spaces).
Verify Password:
Participant's First Name:	*
Participant's Middle Initial:	(Optional)
Participant's Last Name:	*
Extension Unit:	*Required
Address Line 1:	* Address Type
Address Line 2
City:	*
State:	*
Zip Code:	*
Participant's Work Phone:
Participant's Home Phone:
Participant's Mobile Phone:
Participant's E-mail Address:	* This web registration software is currently hard coded to require an e-mail address. Without a valid e-mail address, participants can not receive a registration confirmation, event reminders or password reminders . If the same e-mail address is used for more than one user account, a different password must be used for each person. If a participant does not currently have an e-mail address, it is recommended that one be created through one of the many free e-mail services available and return to set up their account. Alternately, a bogus e-mail address may be entered by creating an address like "FirstNameLastName@Kansas4-H.org". Since Kansas4-H.org does not offer e-mail service, you won't risk information being sent to a real user at an exising address.
Special Needs:	If none, leave blank.

* Required information

Demographic Information

Participant's Gender:	*
Participant's Ethnicity:	*
Participant's Birthdate (mm/dd/yyyy):	/ / *
Disability:

Subscribe to E-mail Notices about Kansas 4-H events and/or programs.
This section allows you to receive special e-mail notices related to the Kansas 4-H events you specify.
Check the programs in which you are interested. Uncheck those programs in which you are no longer interested.

To review your selections, your may return to the top of the page