Register a new user

All fields below are required. If you are the owner, for fastest service register the email account the State WIC Office has on file.

Passwords must be 10 characters long and contain:

1. At least 1 uppercase letter.

2. At least 1 lowercase letter.

3. At least 1 number.

4. At least 1 special character - !@#$%^&* are allowed.

Email Address:

Confirm Email:

Password:

Confirm password:

First Name:

Last Name:

Phone Number:

Company: