X-ray Registration Gateway Access Request The information below is required to obtain secure access to the X-ray Registration System. Only the designated Individual Responsible for Radiation Protection (IRRP) for each facility will be authorized access to the facility's information. By submitting this request, you swear or affirm thay you are authorized to perform business processes for the listed facility. Facility and account verification information: (List the information as it appears on your Certificate of Registration.)

* Name of Individual Responsible for Radiation Protection (IRRP):

* Email Address:

IRRP website access information (IRRP Contact Information):

* First Name:

* Last Name:

* Confirm Email Address:

* Phone Number:

* = required field.