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Primary Account Registration

Please complete the information below to create a Primary Account to the IRIS (Immediate Recognition Increases Safety) Program. After registering this account, it will allow you to sign up family members or anyone close to you who are suffering with Autism to become "Members". That is a members becomes individuals on the Autism Spectrum where you will now have to view Members Details, Members Contact Information, Editing Members and Contact Information, and ordering Products on behalf of members

First Name:*

Last Name: *

Address Line1:*  Address Line2:
City:* State:*
Country:* Postal Code:*
Date of Birth:
Contact#:* Gender:
Work#: Relationship to Member:*
Password:* Email:*
Confirm Password: Confirmation Email: