Together Collection brought to you by Thierry Brenner

Fields marked * are required entries.

Step 1a - all new affiliates must fill out the following

Choose an enrollment type from the drop down list based on your profession or fields of interest.
* Enrollment Type:	( required )
* Music Genre:	( required if Artist )
* Affiliation:	( required if Computer or Music store )
Choose a default language that will be used when someone visits your website, and for e-mail correspondence. Also select your country of origin.
* Preferred Language:	( required )
* Country:	( required )
When filling out the following fields, remember to be accurate. Artists please use the first name field for your band name if only one word is required.
* First Name:	( required )
Last Name:
* E-Mail:	( required )
* Re-enter E-Mail:	( required )
Please, enter your PayPal account email address so we may pay your shares to that account. It can be the same as your regular email above. If you do not have a PayPal account, you can open one from your account "CCC" later.
PayPal E-mail:
Re-enter PayPal E-mail:

Step 1b - to be filled in only if you are an Organization or Non-profit

Organization Name:
Web Site URL:
Number of Members:
Operational Level:
I am:

Step 1c - to be filled in only if you are a division of the Medias

Enter your Company name, and your Call Letters, or Station ID, as applicable. Check this box if you're a division of the medias.
Media Company Name:
Media Call Letters:

Step 2 - Please read the Affiliate Agreement and the Visitor Agreement.
*Enter your initials in this box if you have read and agree with both the
Affiliate and Visitor Agreements.
( required )

Your personal sponsor will be:
Thierry Brenner (ID# tb1160)