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Registration

After you've filled out and submitted this form, you will receive an e-mail message from Jamaica Bay Casino with confirmation and further instructions.

I have read and I agree to the terms of the Referral Agreement.

Contact and Payment Information:
Make sure that the information you enter is correct, as this information is used to both contact you and make checks payable to you.

Name:
Address line 1:
Address line 2:
Address line 3:
Country/Region:
City:
State or Province:
Zip or Postal code:
Phone Number:
E-mail Address:


Login Information:
If you are accepted into the Referral Program, you will need to submit the username and password you enter below to access your account statistics.

Username:
Password:
Re-enter Password:
??? Remember my login information


Describe Your Site:

URL to your site:
? If you have more than one site in your network, you can add more sites later.
You only need to specify one site per domain.

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