First Name
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Last Name
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Date of Birth (DD/MM/YYYY) (All affiliates must be at least 18 years of age)
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Email
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Mobile tel number
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Password
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Password Confirmation
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Briefly tell us how will you promote us?
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Social Media Handles/ Website/ Business Name
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Choose your affiliate code you would like to use e.g. JANE20
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Banking Details for Payment (Bank Name, Account Holder Name, Sort Code & Account Number)
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Payment Email