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Select a Membership Type	Assist.tv Free Personal Listing (free) Free! Add your Videos and Social Networking links to the Assist.tv Directory Assist.tv Business Sponsor Listing ($99.00) Only $99 per year!. Add your video to the Assist.tv Directory for a 50 mile radius of your zip code. If you have not yet paid, we will send a PayPal Invoice to your email.
Payment System	PayPal - secure credit card payment
Your Name your first & last name
Your E-Mail Address will be used to send confirmation
Choose a Log-in Name (User ID) enter preferred user id - it will be used after payment to login into your account. Must be 4 or more characters and can contain small letters, numbers and _	check for uniqueness
Choose a Password Must be 4 or more characters
Confirm your password enter password again
Display eMail Address (Y/N) Display your eMail address on your Member Page?
Website #1 Title Enter the Tile for this Website, Blog, Business, Organization... (40 characters)
Website #1 Homepage URL Enter the URL for the website #1. Please include http://
Website #2 Title Enter the Tile for this Website, Blog, Business, Organization... (40 characters)
Website #2 Homepage URL Enter the URL for the website #2. Please include http://
Website #3 Title Enter the Tile for this Website, Blog, Business, Organization... (40 characters)
Website #3 Homepage URL Enter the URL for the website #3. Please include http://
Phone Number Only enter your phone number if you want it shown.
Street Address (optional) Enter Street Address here for Business listings.
City Name What City do you live in.
State Name What State do you live in? (2 char code)
Zip Code The Zip Code that you live in.
Reseller Do you want to be a Reseller for Assist.tv?
Map Link (Y/N) Include a link to a map for your Business? Paid members only.
Referred By Website? Search-Engine?
My Sponsor Sponsored by Name (or None)
Photo URL Add the URL of your photograph here. Must be GIF or JPG.
Video Embed Code Enter the code here for your video. On YouTubem this is called the Embed code. Copy and paste it here.
Favorite Charity Name Enter the name of your favorite charity here.
Favorite Charity URL Enter the URL of your favorite charity here.
Description Enter a description of your Business, Need, Coupon, Special offer, etc. . (no HTML or script)
Coupon Expiration Date Coupon Expiration Date: MM/DD/YY
eStore URL Enter your eStore URL with the http://
Skype Name Add your Skype Name here. See http://www.assist.com/skype
AOL IM ID Enter your AOL Instant Messenger ID here.
Yahoo IM ID Enter your Yahoo Instant Messenger ID here.
Paypal eMail Address The Paypal email address that you used to pay for your Business Sponsor Listings. (Not displayed)
Apsense Profile URL Enter your Apsense URL with the http://
Blogcatalog Profile URL Enter your Blogcatalog Profile URL here. Include http://
Digg URL Enter your Digg URL with the http://
DirectMatches URL Enter your Directmatches URL with the http://
eBay ID Enter your eBay User IDhere.
eBay Store URL Enter the URL for your eBay Store here
Facebook URL Enter your Facebook URL with the http://
Feedburner URL Enter your Feedburner URL with the http://
Linkedin URL Enter your LinkedIn URL with the http://
Friendfeed URL Enter your Friendfeed URL with the http://
Ning Profile URL Enter your Ning Profile URL with the http://
MySpace URL Enter your MySpace URL with the http://
Plurk URL Enter your Plurk URL with the http://
Ryze URL Enter your Ryze URL with the http://
Squidoo Lens URL Enter your Squidoo URL with the http://
Twitter URL Enter your Twitter URL with the http://
Twitter Feed (RSS) URL Enter your RSS link from the bottom of your Twitter page. (or blank)
Twitpic URL Enter your Twitpic URL with the http://
Twiddeo URL Enter your Twiddeo URL with the http://
TweetPhoto URL Enter your TweetPhoto URL with the http://
Yahoo 360 URL Enter your Yahoo 360 URL with the http://
Viddler URL Enter your Viddler URL with the http://
Vimeo URL Enter your VimeoURL with the http://