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Coordinator Registration

Please complete the following form to register as a coordinator.

If you have already registered with Texas Health Match, please do not re-register. Click Here to login into your account.

- required field.

Coordinator Information

AHEC Center
First Name
Last Name

Contact Information

Phone: (Please enter in format xxx-xxx-xxxx)
E-Mail: (Please enter a valid email since the confirmation email will be sent to you by this address)

Log In Information

User Name:
Password:
Confirm Password: