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Please complete this form to receive your PREPAID CD Activation Code.
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CCAlive! Serial Number
(printed on the card that came with CDs - required for NEW CDs ONLY)
Your Name:
First:
Last:
Username (if not Your Name):
(minimum 6 characters)
Your user name should be a single word, without numbers, spaces, or special characters. Capital letters count, since the CD username is case-sensitive. Choose a user name that your course instructor can readily recognize as belonging to you, such as your first initial plus last name.
Note: The user name is case sensitive, so capitals count. Letters only - no numbers, spaces, or special characters.
Are you a:
Student
Instructor
School Level:
High School
Home School
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Are you using CCAlive! as a component of a distance learning program?
Yes
No
Did your instructor require the use of CCAlive! ?
Yes
No
You purchased CCAlive!:
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Instructor:
(last name, first name)
Select Instructor
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School:
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Your Date of Birth:
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day
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Your Email:
Please report registration problems to
Michael Niederer
.