Urban Life Training Affiliate Sign Up

Sign Up to Become an Urban Life Training Affiliate and receive access to the Urban Life Training Web Portal

First Name

Last Name

Gender

Male
Female

Email

Cell Phone

Home Phone

Home Address

Apartment or Room #

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Zip Code

Where will you primarily use the web portal (check all that apply)?

School(s)
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Other-please specify below:

Other primary place of use

The Affiliate Fee is $8.34 per month, paid anually.