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Volunteer Account Registration

1. Sign Up

Setting up login and validate email
2. Contact Information

Contact info for SERV-KS notifications
3. Credentials

Professional license(s) & certification(s)
4. MRC Registration

Other settings

USERNAME (required)

Username must be at least 6 characters.
Can not contain spaces.

PASSWORD (required)

CONFIRM PASSWORD (required)

Password must be at least 8 characters.
Must contain a special character.

LEGAL FIRST NAME (required)

MIDDLE NAME

LEGAL LAST NAME (required)

PREFERRED NAME (if different)

E-MAIL (required)

CONFIRM E-MAIL (required)

Please make sure both email address fields match.

PRIMARY PHONE # (required)

PHONE TYPE

SECONDARY PHONE #

PHONE TYPE

How did you hear about SERV-KS?*

Other/More Info

By submitting, you agree to receive text and email messages from SERV-KS. Message frequency may vary. Message and data rates may apply.

I have read and accept the terms and conditions.

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