Florida Shorebird Database

User Registration

Personal
First Name	*	(Required)
Middle Initial
Last Name	*	(Required)
Affiliation	*	(Required)
Date of Birth	(MM/DD/YYYY) * * * You don't need to provide your real DOB. Date of birth will only be used for password recovery purposes.	(Required)
Street Address
Address 1	*	(Required)
Address 2
Country	*	(Required)
State/Province	*	(Required)
City	*	(Required)
ZIP/Postal Code	*	(Required)
Mailing address same as above.
Mailing Address
Address 1	*	(Required)
Address 2
Country	*	(Required)
State/Province	*	(Required)
City	*	(Required)
ZIP/Postal Code	*	(Required)
E-mail Address
E-mail	*	(Required)
Re-enter E-mail	* * *	(Required)
Contact Information
Contact information same as above.
Contact First Name	*	(Required)
Contact Last Name	*	(Required)
Primary Contact Phone	* * Format: 123-123-1233.	(Required)
Secondary Contact Phone	* Format: 123-123-1233.
Fax Number	* Format: 123-123-1233.
Create New User
User Name	* * User Name must be between 8 and 50 characters.	(Required)
Password	* *	(Required)
Re-enter Password	* *
	Password must be between 8 and 24 characters, contain at least one lower case letter, one upper case letter, one digit and one special character such as !@#$%^&*(){}[]
Secret Question	*	(Required)
Secret Answer	*	(Required)

Demonstration Website