Affiliate Profile Form

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Affiliate Profile Form
Welcome to the IP UserGroup

As a first time visitor to this page you have probably decided to join the IP UserGroup as an Affiliate Member and wish to submit your details.

So that we can process your membership and create your personalised area on the website please complete the form "Affiliate Signup" below.

It is a simple form and will only take a few minutes, we will need your postal and email addresses, a brief profile of your company, the URL of your logo, number of employees and a few contact details.

* Required fields
Name *
E-mail Address *
Job Title *
Company Name *
Company/Billing Address *
Post Code *
Country *
Telephone *
Fax
Company website URL:
	Media Partner / Associate
Primary Product Category
Secondary Product Category
Alternative Product Category
Company Profile (70 - 100 words) *
URL of Company Logo (gif/jpg) http://
No. of employees *
Purchase Order Reference
Authorised Name *
Key Contact: (name, title, tel & email please) *
Contact Marketing: (name, title, tel & email please)
Contact PR: (name, title, tel & email please)
Contact Web Admin: (name, title, tel & email please)
Contact Sales/Tech (name, title, tel & email please)
Others you wish to register as IP UserGroup Members

I have read and agree to the Privacy Policy *

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Affiliate Membership Terms & Conditions