AffCon 2010 - Florida :: Affiliate Registration Form

Affiliate Registration (Not a working affiliate? Register Here)

	Affiliate Registration
	(Please Fill Out All Fields)
*Email:
*First Name:
*Last Name:
Business Title:
*Company:
*Address:
*City:
*State/Province:
Zip/Postal:
Country:
Phone:	(000) 000-0000
Date of Birth:	(MM/DD/YYYY)
Gender:
Which best describes your business?:
If "other", please describe:
Sample affiliate page URL:
Your Associated Affiliate Neworks:
Industries you promote: (please use Cmd/Ctrl to choose more than one)
Languages: (please use Cmd/Ctrl to choose more than one)
Forums: (please use Cmd/Ctrl to choose more than one)
Methods of Promotion:
Other Promotion Methods:
How did you hear about AffCon Events?
Please list other affiliate websites you run here along with a short note on why you think an affiliate program should sponsor you.	*Informing the affiliate program about yourself will increase your chances of being sponsored.
By checking the box, I agree to the Policy, Terms and Conditions of the confernece and confirm I am over age 21.	I Agree: (please note: there is no guarantee you will be sponsored to this event)