Complete this form to create an account with HTCC. All fields required.
This will enable you to create and edit your Enhanced Directory Listings.
Once you've submitted this form, your email address will be emailed your login information to submit a listing.

Company Name
Contact First Name
Contact Last Name
Contact Phone
Suggested format xxx-xxx-xxxx
Contact Fax
Contact Email

Name and Cert number (if available) of CHT on staff

CHT First Name
CHT Last Name
CHT Number