Licence Application - AB Funeral Services Regulatory Board

Licensee Information

Please provide your personal information below.


First Name	Middle Name	Last Name	Certificate Name
Work Phone Number	Cell Phone	Personal Email

User Account Information

The username for your account will be all lowercase first letter of your first name, first letter of your middle name and then full last name with no spaces. If you do not have a middle name in the system, then the username would be just first letter of your first name and last name.

Example: Name is Jane Dawn Doe - jddoe

Enter a username:

Password

Input and confirm your password.

Passwords must be at least 8 (eight) characters in length and include at least 1 (one) uppercase letter, lowercase letter, number and special character.
Special characters allowed are @ ! $ % & * ( ) - [ ] { } , / : ?

Example: Testing8!


Password:	Confirm Password: