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TRAVELfusion Affiliate Publisher Registration

Travel Publisher -- General Information

Publisher Name
Company Name	*
Publisher Contact Details	Address
Flat
Building Name
Building Number
Street	*
Locality
City	*
Province	*
Postcode	*
Country	*

Phone (We may need to contact you urgently for a number of reasons. These are the numbers we will use)
Intl. Code* Area Code* Number* Extension

Fax
Intl. Code Area Code Number Extension

* Required field

Publisher User Information

User	Login
Username	*
		Must be 6 to 20 characters using a-z and 0-9, including at least one letter.
Name
Title	*
First Name	*
Last Name	*
Email
Email	*
		This is the address we will use when we need to notify you of issues related to your account.

* Required field

I confirm that I accept the terms and conditions¹ set out in the enclosed Affiliate Marketing Partner Services
I hereby confirm that I accept the terms and conditions² set out in the enclosed agreement