10104 Brewster Lane Powell, Ohio 43065 740 938-2000 FAX 740 938-2001

Create A New Account

Thank you for setting up a new account. We believe that your account will become a valuable tool to assist you in staying in touch with our district. If you have any difficulty setting up your account, please contact us at 1-740 938-2000 or email us at bjking@ci.pataskala.oh.us for help.


	Step One: Personal Information [Next Step: Contact Preferences]


	Please provide as much information as possible. Fields in bold* are required.* Please view our privacy policy for information on how we use the information collected and keep it safe.


Prefix:	(Example: Ms, Mrs, Mr, Dr, etc)
First Name:
Middle Init:
Last Name:
Suffix:	(Example: Jr., Sr., III, etc)
Preferred Login ID:
Preferred Password:
Confirm Password:
	NOTE: Below we ask for your mailing address. This information is NOT REQUIRED to create an account, but is VERY HELPFUL for us in communicating with you. Please consider providing us this information if you can.
Address Line 1:
Address Line 2:
City:
State:
Zipcode:

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