A. Who You Are

Full Name:
e-mail address (use the address given to you by the ISP you are using to connect) (no webmail or free addresses- hotmail, etc.):
Your Site:
First Name:
Middle Initial:
Last Name:
Phone number:
FAX:
Date of Birth:	(11-Oct-71)
Passport #:
Future US Corporate Name:
Home address
Street:
Street (additional):
City:
Province / State:
Postal Code:
Country:

B. Affiliate and Login Info

Choose your Affiliate/Login ID: up to 16 numbers or letters or both
Password (6-10 characters):

C. Business Forwarding Address

mail will be forwarded to you @
Name:
Street:
City:
State/Province:
ZIP/Postal code:
Country:
Print Address Exactly How it Should Appear On an Envelope Addressed to You (First Line must be Name -- Last Line must be Country):
Address Label

Please describe your business in detail