Atomy Sign-up Form

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Atomy Sign-up Form

Email *

Country *

First Name *

* must match government ID.

Last Name *

* must match government ID.

Gender *

Female

Male

Social Insurance Number (SIN #) *

Member is required to submit the full 9 digits SIN # in order to receive commission. SIN cannot be changed once you are registered. Please check to make sure your SIN # is accurate. False SIN # or making duplicate accounts will result in termination of membership.

Date of birth *

YYYY

Phone number *

Address *

City *

Province *

Postal Code *

Comments or questions

By using this form, you agree to release your information to www.atomysignup.com to sign up for an Atomy account on your behalf as the sponsor. Client confidentiality is important and www.atomysignup.com will do its best to keep your information safe and private. www.atomysignup.com will not sell or repurpose your information without your written consent. *

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