SCHEDULE OF EVENTS

PARTY WITH OTHER AFFILIATES!

Go to Affiliate Convention Party 2011 FOR FREE!

Fill out the form below. Fields marked with a * are required

* Select Event:
* First Name:
* Last Name:
* Website:
Title/Position:
Company:
* Address:

* City:
State:
* Zip Code/Postal Code:
* Country:
* E-Mail:
* Telephone:
Fax:

* Which best describes your business? (Check all that apply)
Affiliate Network Merchant Affiliate Manager	Agency Payment Processor Other (Please Describe)
* What Industries are you currently promoting or plan to promote in the next 12 months? (Check all that apply)
Adult Antiques / Art / Collectibles Automotive / Boat Baby / Children Business & Industrial Books Clothing Dating Diet, Health & Beauty Electronics Entertainment / Movies / Music Financial / Banking / Real Estate	Games (non-gambling) Gambling/Casino Gift Certificates Home & Garden Insurance Jewelry / Watches Medical / Pharmaceutical Mobile / Telecom Software Sporting Goods & Memorabilia Technical Tickets / Events Toys & Hobbies Travel
* What Regions of the World are you currently promoting to or plan to promote in the next 12 months? (Check all that apply)
North America South America Europe	Eastern Europe (incl. Russia) Asia Mid East / Africa
* What languages are you currently promoting to or plan to promote in the next 12 months? (Check all that apply)
English Spanish German French Italian Swedish / Norweigan Russian Other European	Japanese Mandarin / Cantonese Korean Other Asian Other
* What forums are you a member of? (Check all that apply)
ABW WickedFire	5 Star Not a Forum Member
* Please advise your primary methods of promotion as an affiliate (Check all that apply)
Pay Per Click Search Engine Optimization Email marketing Offline Marketing Coupons Blogs / Content	Rebate sites Shopping portal Social / Viral marketing Loyalty / Member sites Other (Please Describe)
How did you hear of this event?
	If you were referred by someone (or a web site), please enter the name below:
Comments: Please list any comments or requests you have for the affiliate program. You can list other websites you have here as well as why you think the affiliate program should sponsor you. (Informing the affiliate program about yourself will increase your chances of being selected)

Security Code:

You are registering 1 ticket for the Los Angeles Affiliate Convention Party. It is a free event.

By checking the box below, you agree to the Policy, Terms and Conditions of the conference.

I AGREE (Required)