Affiliate registration form

Title	- Please Choose - Mr Mrs Miss Ms Dr Prof Other
First name
Last name
Email address	(this will also be your user ID)
Full address
Type of affiliation you would like	I'd like a complete web site similar to this one I'd like to add your price comparison tables to my own site I'd like to use your datafeed and develop my own feed-driven site
Which domain name would you like?	http://www. (if using your own site)
Do you own any other web sites?	No Yes, I have
Please choose a password
Please confirm your password	(re-type the same password in this box)
Please tell us what you are hoping to achieve and how you plan to promote your web site

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