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Select a Membership Type	Business Coaching - 30 Minutes ($49.00) See http://assistcoach.com Social Friends [FREE] see http://SocialFriends.org (free) Membership in the Social Friends Organization where you can meet your virtual friends Live! Assist Directory [FREE] http://www.assistdir.com/grow (free) Add your Business to the Assist Directory for FREE. Be sure to specify your zipcode so that we know what pages to put you on. Gold Membership [MONTHLY] http://www.assistdir.com/gold ($5.95) Add your Business link to all the Zip Code pages for 1 entire State! Only $5.95 per month. Gold Membership [YEARLY] http://www.assistdir.com/gold ($49.00) Adds your Business Link to ALL Zip Code pages for 1 City for 1 Year for only $49.00 Platinum Membership [MONTHLY] http://www.assistdir.com/platinum ($19.95) Includes your listing for 1 Business in all Zip Codes and Cities in the USA. Total of 43,191 pages! Pay here, http://www.assistdir.com/platinum Please allow 3-5 days for your links to be added. Platinum Membership [YEARLY] http://www.assistdir.com/platinum ($199.00) Includes your ad for all Zip Codes and Cities in the USA. Total of 43,191 pages! Pay here, http://www.assistdir.com/platinum Please allow 3-5 days for your links to be added. 10,000 Banner Impressions. [MONTHLY] ($9.95) Display your banner 10,000 times per month in our Banner Rotator. 20,000 Banner Impressions. [MONTHLY] ($14.95) Display your banner 20,000 times per month in our Banner Rotator. 30,000 Banner Impressions. [MONTHLY] ($19.95) Display your banner 30,000 times per month in our Banner Rotator. 40,000 Banner Impressions. [MONTHLY] ($24.95) Display your banner 40,000 times per month in our Banner Rotator. 50,000 Banner Impressions. [MONTHLY] ($29.95) Display your banner 50,000 times per month in our Banner Rotator.
Select a Payment System	StormPay - See www.stormpay.com for description 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 #1 Feed URL Enter the Atom,RSS,XML Feed URL (if any) for website #1.
Website #2 Title Enter the Tile for this Website, Blog, Business, Organization... (40 characters)
Website #2 Homepage URL Enter the URL for the website #1. Please include http://
Website #2 Feed URL Enter the Atom,RSS,XML Feed URL (if any) for website #2.
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://
Website #3 Feed URL Enter the Atom,RSS,XML Feed URL (if any) for website #3.
Phone Number Only enter your phone number if you want it shown.
Street Address (optional) Enter Street Address here for Retail Merchants.
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.
Photo URL Add the URL of your photograph here. Must be GIF or JPG.
Favorite Charity Name Enter the name of your favorite charity here.
Favorite Charity URL Enter the URL of your favorite charity here.
Coupon / Special Enter your Coupon or Special Promotion here to include in our Coupon Directory. (no HTML)
Coupon Expiration Date Coupon Expiration Date: MM/DD/YY
eStore URL Add your eStore URL here. You can also use your Assist eStore URL
Referred By Website? Search-Engine?
My Sponsor Sponsored by Name (or None)
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.
Banner Graphic URL Enter the URL to your 468 x 60 banner.
Paypal eMail Address The Paypal email address that you used to pay for your listings. (Not displayed)
Apsense Profile URL See http://www.assist.com/grow
Blogcatalog Profile URL Enter your Blogcatalog Profile URL here. Include http://
DirectMatches URL Enter your DirectMatches URL here. Join at http://www.assistdir.com/dm
eBay ID Enter your eBay User IDhere.
eBay Store URL Enter the URL for your eBay Store here
Feedburner URL Add your Feedburner or Blog RSS feed URL here.
Linkedin URL Enter your LinkedIn URL here (or blank)
Ning Profile URL See http://www.assist.com/grow
MySpace URL Enter your MySpace URL here (or blank)
Plurk URL Add your Plurk URL or username here.
Ryze URL Enter your Ryze URL here. See http://www.assist.com/grow
Squidoo Lens URL Add your Squidoo Lens URL here. http://www.assist.com/grow
Twitter URL Add your Twitter URL here. http://www.assist.com/twitter
Twitter Feed (RSS) URL Enter your RSS link from the bottom of your Twitter page. (or blank)
Yahoo 360 URL Enter your Yahoo 360 URL here (or blank)
Direct-Sales.Info URL Enter your Direct-Sales.Info URL here.
Google Ad Client ID Add your Google Adsense Client ID here to earn money from your listings.