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First Name:	*
Last Name:	*
Please enter the email address that the public may use to contact your website.
Public Email Address:	*
Please enter your private personal email address for our mailings to you. This is not displayed or shared to the public.
Private Email Address:	*
Business Mailing Address:	*
City:	*
State:	*
Zip/Postal Code:	*
Country:
Business Telephone	*
Website Name:	*
Website URL:	*
Brief Description of what your site is about:	*
Is your website an MLM - money-making scheme or home mailing scheme etc.?
	No Yes
Membership
Membership is available as lifetime certification.
	Lifetime Membership: $19.95 USD
Privacy Policy
Membership requires that your site display prominently a Privacy Policy link on your home page.
	I have an existing privacy policy already displayed. I do NOT have a privacy policy in place.
URL of Privacy Policy	*
Check to Sign
	I agree to the terms & conditions set forth in the application. I further understand that violation of said terms may result in revocation of certification without recourse nor refund.
Security code:	*

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