This form is used to submit a request to add a new contact.
Provide values for the column listed below and then click the Submit Form.
IMPORTANT: This request will be submitted to ACLC and processed the next business day.
Click Return to Registration Maintenance link to go to Registration Maintenance screen.
Click Return to Registration List link to go to Registration List screen.
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Given Names: |
Enter the contact individual given name |
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Last Name: |
Enter the contact individual last name |
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Date of Birth: |
Date of birth |
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Gender: |
Select Male/Female |
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Home Phone: |
The home telephone number including area code. (optional) |
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Work Phone: |
The work telephone number including area code. (optional) |
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Cell Phone: |
The cell telephone number including area code.. (optional) |
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Email Address: |
Enter contact email address |
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Mailing Address: |
Enter full address including City, Prov and Postal Code. |
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Requested By: |
Enter the name of the person who is completing this request. |
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Contact Phone: |
Provide a phone number for the person who is completing this request. |
NOTE: The new contact will NOT be available until it has been processed by the AGLC, usually on the next business day.