Leduc County Fire Services

Step 1. Create Billing Contact

Step 2. Activate Account

Step 3. Account Activated

Contact Information Note: Red text indicates required fields.

Billing First Name:

Billing Last Name:

Region:

City:

Phone 1:

Email:

Client #:

Job Title :

Account Information

Username:
		* We suggest your email address (Min Characters: 5)

Password:

Re-Type Password:

Password Strength

Note: For the best Password Strength rating include:

Extra Information

Emerg. Contact:

Emerg. #:

Permission To Take Photo(s) Granted

Medical Information

Do you have any of the following conditions or requirements?:

Allergies:

Yes

Other Medical Conditions:

Yes

Please explain:

Security Check

Captcha Verification