New User Registration / Account Activation

Anonymous User Registration

Use this form to create an account if 1) You are a first time user AND 2) You are not currently a City of Bethlehem Utility Billing Customer or Real Estate Owner. Once this account is created you will be able to 1) Enter a Service Request, 2) Reserve a Parks Facility, or 3) Register for a Parks Program.

Name (Last First MI) *
Mailing Address Line 1 *
Mailing Address Line 2
Mailing Address Line 3
Mailing City/State *
Mailing Zip *
Primary Phone *	(10 digits; no special characters)	Ext

Email *
User Name *
Password *	(6-character minimum; no spaces)
Verify Password *
Secret Question *
Secret Answer *
Marital Status

* = Required field