Affiliate Referral Log Please enable JavaScript in your browser to complete this form.Your Name *FirstLastYour Email *Your Affiliate #Who are you referring?Name of Referral *FirstLastReferral's City *Referral's State *Referral's Contact NumberReferral's Email *Does the Community Heroes Program have permission to contact your referral? * Yes, they are expecting your contact within 2 business days.No, they will contact the Community Heroes Program independently.Please add any additional information (optional)CompensationBy submitting this form, you represent that you understand and agree to the following: Dewlyn LLC will pay a one-time fee of $50 for each Academy Member that joins as a result of being referred by you. To receive a referral fee, your referral will need to become a member within 90 days of the date of this referral log entry. We pay one referral fee per member, one time only.NameSubmit
