CordilleraID Credential Request

2. CordilleraID
   CordilleraID is a state-of-the-art, encrypted ID card that Cordillera residents use to access Cordillera facilities. The card and the door locks that support them allow Public Safety staff remote, centralized access control of all Cordillera facilities. The cards contain a unique, encrypted identifier that cannot be cloned or duplicated. This will help to ensure that Cordillera amenities are being access by only approved individuals.

   CordilleraID is a state-of-the-art, encrypted ID card that Cordillera residents use to access Cordillera facilities. The card and the door locks that support them allow Public Safety staff remote, centralized access control of all Cordillera facilities. The cards contain a unique, encrypted identifier that cannot be cloned or duplicated. This will help to ensure that Cordillera amenities are being access by only approved individuals.

4. First Name*

5. Last Name*

7. Street Number*

   Club members who are not Cordillera property owners should use their non-Cordillera address information.

8. Street Name*

   Club members who are not Cordillera property owners should use their non-Cordillera address information.

10. Email Address*

11. Phone Number*

    Numbers only. For example: 9709261923

13. Photo*

    Click the "Browse" button on the right side of the field to select a photo of yourself. A standard selfie will do. Be sure your face is clearly visible and ensure that you are not wearing a hat or sunglasses. Minimum photo resolution is 250px x 250px.

15. Add a household member?

    1. Yes
    2. No

    If you would like to request a CordilleraID card for another member of your household, please select yes.

16. Equestrian Boarding*

    1. Yes
    2. No

    Are you boarding a horse at the Equestrian Center?

17. Cordillera Club Member*

    1. Yes
    2. No

    Are you a Cordillera Club member?

19. Mailing Address
    Please indicate the address you'd like your CordilleraID card mailed to. Due to Covid-19 restrictions, all CordilleraID cards will be sent through the US Postal Service.

    Please indicate the address you'd like your CordilleraID card mailed to. Due to Covid-19 restrictions, all CordilleraID cards will be sent through the US Postal Service.

21. Mailing Address*

23. City*

24. State*

25. Zip Code*

29. First Name*

30. Last Name*

32. Street Number*

33. Street Name*

35. Email Address*

36. Phone Number*

    Numbers only. For example: 9709261923

38. Photo*

    CordilleraID requires a photo for each cardholder. Click the "Browse" button on the right side of the field to select a photo of yourself. A basic selfie is preferred. Please be sure that your face is clearly visible and that you are not wearing a hat or sunglasses.

40. Add a household member?

    1. Yes

    1. No

    If you would like to request a CordilleraID card for another member of your household, please select yes.

44. First Name*

45. Last Name*

47. Street Number*

48. Street Name*

50. Email Address*

51. Phone Number*

    Numbers only. For example: 9709261923

53. Photo*

    CordilleraID requires a photo for each cardholder. Click the "Browse" button on the right side of the field to select a photo of yourself. A basic selfie is preferred. Please be sure that your face is clearly visible and that you are not wearing a hat or sunglasses.

55. Add a household member?

    1. Yes

    1. No

    If you would like to request a CordilleraID card for another member of your household, please select yes.

59. First Name*

60. Last Name*

62. Street Number*

63. Street Name*

65. Email Address*

66. Phone Number*

    Numbers only. For example: 9709261923

68. Photo*

    CordilleraID requires a photo for each cardholder. Click the "Browse" button on the right side of the field to select a photo of yourself. A basic selfie is preferred. Please be sure that your face is clearly visible and that you are not wearing a hat or sunglasses.

70. Add a household member?

    1. Yes

    1. No

    If you would like to request a CordilleraID card for another member of your household, please select yes.

74. First Name*

75. Last Name*

77. Street Number*

78. Street Name*

80. Email Address*

81. Phone Number*

    Numbers only. For example: 9709261923

83. Photo*

    CordilleraID requires a photo for each cardholder. Click the "Browse" button on the right side of the field to select a photo of yourself. A basic selfie is preferred. Please be sure that your face is clearly visible and that you are not wearing a hat or sunglasses.

Leave This Blank:


85. 1. Receive an email copy of this form.
86. Email address

    This field is not part of the form submission.

87. Submit

* indicates a required field