Phone Cards (Prepaid Phone cards) - International Long Distance Phone Cards

Campus Rep Program Application Form

Information About Yourself
Name:
	*First*	*M.I.*	*Last*
Password:
Confirm Password:
Street:
Suite #:
City:
State:
Zip Code:
Email:
Phone:
Information About Your School
School Name:
Domain Name:	(your_school.edu)
Program:
Year to graduate:
Number of Students

Please fill in this field if you are applying on behalf of an organization
Organization Name:
Your Title:

Please briefly describe how you plan to promote our site on your campus

By submitting this application form, I declare that I am a full time student, and that I accept the Operating Agreement of the Campus Rep Program.

Last Update: November 19, 2004.