Registration

Please complete this form to request website access. Once submitted, your information will be verified by either your agency's Safety Coordinator or PDRMA staff, and you will receive a system-generated email if your access is approved. Please allow up to two business days to complete this verification process.
Note: Required fields are marked with an asterisk (*).

Agency

* Agency

Your Contact Information

* Email
The email you provide will be your login username. Provide your work email address (if you have one), otherwise use your personal. If you participate in PDRMA Health, you may specify a different email for Health communications by contacting PDRMA Health (630.435.8898)
* First Name
Middle Initial
* Last Name
Preferred Name

Health Program Dependents Registering for PATH Access

Check this box if you are a dependent of someone who works for one of our members and have your health coverage through the PDRMA Health Program.
Please enter the first and last name of the Health Program participant through whom you have health coverage.
* First Name
* Last Name

Your Work Information

* Primary Department
* Job Level
* Job Title

Account Security

Please choose a password that meets the following specifications:

  • Minimum of six characters.
  • Minimum of one capital letter.
  • Minimum of one number.
  • Minimum of one special character.
  • * Password
    * Confirm Password