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  Site Registration

Thank you for joining Crosspointe!
Please complete the application below. Once you have done so, click the Register Now button to
send your information to us. We will process your application as soon as possible.
(*=required field)
Username*:
Name to be used when accessing this site
Email Address*:
Valid email address
Confirm Email Address*:
Confirm Valid email address
Prefix:
Your Prefix:
First Name*:
Your First Name
Last Name*:
Your Last Name
List other adults:
Other adults in the home
Children and Birthdates:
List children (if any) and birthdates





Include child information in our members only online directory, printed directory only, both, or neither?:
Your directory status
Online
Printed
Both
Neither

Phone*:
Your home phone number
Mobile Phone:
Your Mobile Phone Number
Business Phone:
Your Business Phone Number
Emergency Contact:
The person to contact in case of an emergency
Relationship:
Your relationship to the contact person
Phone:
The phone of the contact person

House Number*:
The number of your house
Street Name*:
The name of your street

City*:
Your City
State*:
Your State:
Zipcode*:
Your Zipcode

Are you a resident, associate or neither*:
Click the appropriate option
Resident
Associate
Neither
Do you agree with and accept our site Terms of Use?*:
Select the appropriate response
No
Yes