Become an Agent

First Name: A value is required.

Initial: A value is required. If you do not have a middle name then please make up and initial because we want everyone to have an initial.

Birth Date: mm/dd/yyy A value is required. Invalid format. If you represent a company then please uses your own birthdate.

Sex: A value is required.

Email Address: A value is required. Invalid format.

Please leave your phone number in the format: 000-000-0000
If your number is not in that format then please type in all Zeros and then leave your correct number in the comments box.

Phone Number: A value is required. Invalid format.

Address Line 1: A value is required.

Address Line 2:

Address Line 3:

City: A value is required.

Province/State: A value is required.

Postal or Zip Code: A value is required.

Country: A value is required.

Registration Category

Please indicate whether you are registering yourself personally or are registering a web site or company etc. You can only register one way each time, but you can register several times under different categories if you wish.

Are you registering yourself personally as an Agent? PersonalAgent

Are you registering a Web Site? WebSiteAgent

Web Site URL- Leave this blank if you are not registering a web site.

Are you registering a Company? CompanyAgent

Company Name- Leave this blank if you are not registering a company.

Are you registering a Newspaper ad? NewspaperAdAgent

Newspaper Name- Leave this blank if you are not registering a newspaper.

Are you registering a Magazine Ad? MagazineAdAgent

Magazine Name- Leave this blank if you are not registering a magazine.

Are you registering a TV show? TVShowAgent

TV Show Name- Leave this blank if you are not registering a TV show.

Are you registering a Radio show? RadioShowAgent

RadioShow Name- Leave this blank if you are not registering a radio show.

Marketing Selling

Choose if you would like to just market or would like to sell as well. Selling earns a greater commission. Selling involves convincing people to buy right now. Marketing is presenting people with material and leaving them to decide on their own to buy later. Marketing can be a simple as referring people the www.TheQ.ca web site. Selling can be quite involved where you set up your own store front or web site, bring people in and then sell them what they are looking for, namely pain relief and optimal health. The final phase is done on our web site. Once you learn how to contact people then things flow pretty easily.

I would like to do marketing and selling.

I would like to do Marketing/Advertising Only please.

Promotion Code: (Just ignore this section if you do not have a promotion code already.) A value is required.

Please tell us a little about yourself and why you want to become a marketing Agent.

Comments about yourself: (Please type between 100 and 500 characters .)

  A value is required.Minimum number of characters not met.Exceeded maximum number of characters.