Clinical Immunity - affiliate Registration

Affiliate Registration

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Affiliate Information
Fields marked with an asterisk are required input fields.

First Name *

Last Name *

Company Name*

Address *

Address 2

City *

State or Province *

Postal Code (ZIP) *

Country *

Telephone Number *

E-Mail Address *

Social Security #*

Who do we make your checks payable to? *

Payable to? *

Your main website URL? *

Your Account Number will be chosen for you. It will be sent to you via email once your account has been approved. Your Account Number is used to track the clicks from your advertisements.

Your Username will be used when you log in to check your account statistics and information. Please write it down.

Choose a User Name
User Name *

Choose a Password for your account.

Choose a Password
Password *
Verify Password *

Program Features:

20% commissions

10 year cookie life

Numerous promotional aids including:

Signature Ads
Banners Ads
Ezine Ads
Text Links
Pop Up Ads
Pop Under Ads

After registering, you will have access to these resources here

Email:glucanol@clinicalimmunity.com