Children’s Environmental Health in Michigan

Request account

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Complete and submit the following form to request a user account.

Make sure that you first read the Terms of Service before requesting an account.

Once the account is approved, you will be emailed a notification message and the account will be usable at login.

User account

A confirmation message will be sent to your email address once you submit this request. The address will not be published. Please respond by clicking on the confirmation link provided by the email. Finally, your password will be emailed to you when your account is created.

Personal information

Your biography will be set as the initial content for your userpage. Make sure you are comfortable publishing such information.

Try to include any relevant credentials in your biography below.

Personal biography (plain text only):

Other information

The following information is kept private and will only be used for this request. You may want to list contacts such a phone number to aid in identify confirmation.

Resume or CV (optional):

Additional notes:

List of websites, if any (each on a separate line):

Terms of Service