LoseTheBackPain.com's Affiliate Program


The Lose The Back Pain Affiliate Program is a great way for you to make some extra money while helping others eliminate their back pain and enjoy life again.


Contact Information
First Name *
Last Name *
Email *
Phone 1 *
Phone 1 Type
Street Address 1 *
Street Address 2
City *
Postal Code *
SSN or Tax ID (USA only) *
State *
Please provide your Skype ID.
Please provide a link to your LinkedIn Profile.
Website (If none, enter N/A) *
How did you hear about our program? *
How do you Intend on promoting our program? What are your marketing plans? *
Do you have experience in the health niche? *
Why do you want to promote our products? *
Do you have a mailing list? If so specify size *
Do you have Affiliate experience? *
If so, what kind of success have you had?
Referral Partner Signup Information
Username *
Password *
Retype Password *
Notify On Lead
Notify On Sale









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