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  AFFILIATE PROGRAM REGISTRATION FORM
  Site Information:
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Site Name:
 
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Site URL:
 
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  Contact Information:
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Name:
 
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Phone Number:
 
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Fax:
 
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Address:
 
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City:
 
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State/Province:
 
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Postal/ Zip Code:
 
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Country:
 
-- Please select one --
United States
Canada
Australia
United Kingdom
India
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Ba
Argentina
Armenia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Her
Botswana
Bouvet Island
Brazil
British Indian
Brunei Darussa
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
CapeVerde
Cayman Islands
Central Africa
Chad
Chile
China
Christmas Isla
Cocos (Keeling
Colombia
Comoros
Congo
Cook Islands
ERTO RICOCR Cos
Cote D'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Repu
East Timor
Ecuador
Egypt
El Salvador
Equatorial Gui
Eritrea
Estonia
Ethiopia
Falkland Islan
Faroe Islands
Fiji
Finland
France
France, Metrop
French Guiana
French Polynes
French Souther
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDo
Honduras
Hong Kong
Hungary
Iceland
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Lao People's D
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Ja
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islan
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Fe
Moldova, Repub
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands An
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Maria
Norway
Oman
Pakistan
Palau
Panama
Papau New Guin
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Qatar
Reunion
Romania
Russian Federa
Rwanda
Saint Kitts an
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and P
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Island
Somalia
South Africa
South Georgia
Spain
Sri Lanka
St. Helena
St. Pierre and
Sudan
Suriname
Svalbard and J
Swaziland
Sweden
Switzerland
Syrian Arab Re
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and T
Tunisia
Turkey
Turkmenistan
Turks and Caic
Tuvalu
Uganda
Ukraine
United Arab Em
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City S
Venezuela
Vietnam
Virgin Islands
Virgin Islands
Wallis and Fut
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
Afghanistan
Albania
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  Preferred Payment Method
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Please Choose One:
 
Credit my account
Send me a Check
 
 
  A little more about your website
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Description:
 
How did you hear about us?
 
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Average # of page views/month:
 
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Please provide us with the URL of your website's logo.
 
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Please tell us when your website was established. (mm/dd/yyyy)
 
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  Help us spread the word
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Do you know anyone else who may
be interested in joining our program?
Name:
 
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E-Mail Address:
 
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E-Mail Address:
 
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Name:
 
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E-Mail Address:
 
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