Welcome

New Client Registration

Please do not fill out this form until you have participated in a CTC’s client information session. Check the online calendar for the next information session date and then call 312-906-9908 to register for a session.

Use the form below ONLY If you have not previously registered - . [Here is why]

Please complete BOTH of the following two data entry pages.

If you HAVE previously registered, and wish to make a change in your data or P-Code, click here.

Title (optional): (e.g: Mr., Ms., Dr., )
Name: *First*	Initial *Last*
Choose a personal code (7 characters) which you will use for entering subsequent information about yourself. ..something you can remember - but which others won't guess. For example, the first three letters of your last name, followed by the last 4 digits of your social security number?
7-character "P-Code"	(Remember this code. If you forget it later, see the CTC host)

Click here to continue with page 2:

Note: All data collected here is for the exclusive use by CTC personnel and volunteers in support of services for its clients. Personal information will not be used for any other purpose, nor shared with others.

cdata/nreg1