WCCS - Set Up Account

Set Up An Account

This page allows you to setup a new Industry Portal account. Please fill in the following fields and click "Create Account" at the bottom of this page when you are finished. If you do not want to create an account, please click "Cancel". In order to create a new account you must fill in all the fields marked with a red star ( * ).

NOTE: The email address you fill in will be your User Name to access the Industry Portal. Please fill in an email address that you have access to, as you will need access to this email address to activate your account.

Personal

*First Name:
Middle Initial:
*Last Name:
*E-mail Addess (User Name):
*Password:
*ReType Password:

Phone

*Phone Number:
Phone Extension:
Fax Number:

Address

*Street:
Optional Street:
*City:
*State:
*Zip/Postal Code:
*Country:

Position

Position Title:
Department Name: