Personal Growth Professional

Peace Promoter Signup Form

First Name:	(required)
Last Name:
Username:	(required)
Password:	(required)
Email:	(required)
Website :	(e.g. www.mysite.com) [How you'll be listed on our promoters page.]
Company:
Street:
City:
State:
Postal Code:
Country:
Phone:
List Size:	(i.e. Number of subscribers.)
Top 200 List*:	Show my name if I'm in the top 200 promoters!

* Some people don't want others to know the charities they support, or at what levels. We respect your privacy if you feel this way. If you don't mind appearing publicly on our list of Top 200 Peace Promoters, then leave the checkbox checked. Otherwise, please uncheck the checkbox. If you your efforts to promote peace are in the top 200, we'll list you according to your efforts as shown on your Peace Impact Meter. [You'll see this when you log in to the official 10 Million Clicks For Peace website (later).]