Affiliate Registration Form

Applicant First Name *

Applicant Last Name *

Applicant Email *

Applicant Phone *

Association Name *

Association Website *

Association Phone *

Foundation Date

(dd.mm.yyyy)

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Association Logos *

File types permitted: jpg, gif, png, tif, eps

File Upload

Click or drag files to this area to upload. You can upload up to 3 files.

File types permitted: jpg, gif, png, tif, eps

Description of the Association *

President First Name *

President Last Name *

President Email *

President Phone *

General Manager First Name *

General Manager Last Name *

General Manager Email *

General Manager Phone *

Marketing Contact First Name *

Marketing Contact Last Name *

Contact Person for Marketing (email) *

Additional Contact Phone *

Main Contact *

We will refer to the Worlddidac Contact when we need to get in touch with your business.