DiversityShop
Associate Program - Registration Form

Please provide the following contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country	United States Canada
Work Phone
FAX
E-mail
Website

Briefly, what is the focus of your organization?

Briefly, how do you see the our products as being of interest to your Members/Network?

How do you plan to alert your network to the products in DiversityShop?

Information and link sent by email.
Information and link on your Website.
Both

Which of the following pages on our site would you like your link to be directed to?

Our Storefront (Listing of all categories)
Our Career/Job Development Resources
Our Disability Resources
Our Diversity Resources

Additional Comments: