New Account Registration
Personal Information
All fields (
*
) marked are required. (Please enter these values as they appear on your CatCard.)
*
First Name:
*
Last Name:
*(Non-UA Exempt)
CatCard Number:
*
Phone:
*
Email:
Department
*
Department Name:
*
Department Address:
*
Department Phone:
*
Affiliation:
Select One
Faculty
Grad
UGrad
Staff
Non-UA
Account Information
*
UA NetID
(or Prefered Username for Non-UA):
*
Type of account:
BioDesk (Unix/GCG)
ARL Domain
SOPWiki
SLM
Faculty Rep., Advisor, or PI Info
Check if you are the PI, else fill out the form.
*
First Name:
*
Last Name:
*
Email:
*
Mailing Address (Bldg & Room #):
*
Bookkeeper or Business Manager:
Current Research/Additional Info
*
Please provide a brief description as to how you will be using this account and if you will need a MySQL database: