Registration

Register for our contest by filling out the form below. Registration is required for voting.

General Information   * First Name:     * Last Name:     * Birthday:   ---Select One--- January February March April May June July August September October November December   - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   - 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914   * Gender:    Male      Female   * Public Name:       Must be 4-10 characters   * Email:       Only one registration is allowed per email address.   * Confirm Email:     * Phone:       Will only be used to contact winners.   * Postal Code:     * Did you know you can schedule appointments online?   Yes     You can now schedule your appointment online for doctor's within the Piedmont Athens Regional network.           Yes! I'd like to receive health tips and news about events and local causes from Piedmont Athens Regional.           Yes! Send great offers and promotions from OnlineAthens/Athens Banner-Herald and its sponsors to my email.   Password Information   Passwords must be 8 to 20 characters.   * Password:     * Confirm Password:

Double check to make sure your information is correct and then hit submit below. Thank you for your participation. By submitting the form you are confirming you are at least 13 years of age and have read and agreed to our terms of service, privacy policy and rules.