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    * required fields
    Web site name
  Web site URL
  Describe your site
* How did you hear about our program?
 Category - What is the main topic of your site? 
  * Payout Option
  * First name
* Last name
* Phone
* E-mail (Used for login)
* Password (Used for login, min. 6 characters)
* Retype password
  * Pay To Name
* Street
   Street2
* City
* State
* Postal code
   Country
   Organization phone
   Organization fax
* SSN/EIN (required for US only)
 
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