Core Diet Affiliate Registration

If already have a user account with the Core Diet, please contact usHEREand we'll add an affiliate account to your existing user account (your contact to us for an affiliate account, is your acceptance of ourterms and conditionsof use)! Otherwise, sign-up below for an affiliate account, and we will review your application ASAP. If approved, you will be granted access within 48 hours!

First Name*
Last Name*
Company Name
Username*
Password*
Password Re-type*
E-mail*
Address*
City*
State*
Phone
Tax ID*
Checks payable to *
Website *
I have read and understand theterms and conditions.