Affiliate sign-up form - Powered by Keap

Welcome to Wendy Lipton-Dibner's Professional Impact

Affiliate Registration Page

Wendy pays generous commissions to ethical marketers who are committed to making a greater difference through her content.

Please complete the form below and click the red button at the bottom. You will receive an email with your unique Referral Partner code and information to access our Partner Resource Center.

Thanks, in advance, for your support and friendship. We look forward to serving your referrals and sending you HUGE checks!

First Name *
Last Name *

Email *

Cell Phone

Work Phone *

Where do you want us to send your commission checks?

Street Address 1 *
City *
State *
Postal Code *
Country *

Important Please enter either your Corporate Tax ID or your SS#. We need this information to release your commissions.

Tax ID

SS# (if no Tax ID)

Choose a username and password that will be your unique login for the Affiliate Resource Center

Username *

Password *

Confirm Password *

Notify on Lead

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Notify on Sale

YesNo