Create New User Account
User Credentials
First Name *
Last Name *
County *
Select the county to which this user will report volunteer hours.
Username *
The username must be UNIQUE in the system. A username that is already in use will cause an error message upon attempting to save the record.
Password *
Repeat Password *
Email *
 
Every user should have an email address in the database except for cases where a Master Gardener does not have an email address and will not likely be submitting their hours through the online system.
Address Information
Address 1
Address 2
City
State
Zip
Phone
Include area code, please.
Notes
Emergency Information
Please Note
Provide as much information as you can but submit at least one Emergency Contact and phone number. Provide phones with area code first.
Emergency Contact 1 *
Contact 1 Phone 1 *
Contact 1 Phone 2
Emergency Contact 2
Contact 2 Phone 1
Contact 2 Phone 2
Doctor
Doctor Phone
Insurance Company
Insured Name
Insured Relation to You
Policy ID
Medications List
Publicity Release
Publicity Release Statement
I authorize K-State Research and Extension and the Kansas Master Gardener Program or their assignees to record and photograph my image and/or voice for use in research, educational and promotional programs. I also recognize that these audio, video and image recordings are the property of K-State Research and Extension and/or the Kansas Master Gardener Program.
I agree to the Publicity Release Statement *
Yes
* Required field(s)
Create New User Account