Affiliate Area

Affiliate Program Registration

Name(Required)

First Last

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Social Security Number (Required for USA Citizens Only)(Required)

Social Security Number (Required for USA Citizens Only)

1099-MISC forms(Required)

I accept 1099-MISC forms to be emailed.

Username

Password(Required)

Enter Password Confirm Password

Paypal Payment Email(Required)

How will you promote?(Required)

Website (if applicable)

This field is for validation purposes and should be left unchanged.

IMPORTANT NOTICE FOR AD COPY:

It is illegal to use the words Cure or Treatment. Use the word Therapy
It is illegal to use the word Heal without the adverb Help or Support. Use Helps Heal or Supports Healing

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