Thank you for enrolling in the second year of the Agents of Black Project program. 

We need to collect some information from you so that we can keep in touch with you throughout the next year (and also so we can get your t-shirt and other merchandise ordered so you can get it ASAP when the program starts in August 2016). 

Name *
Name
Address *
Address
Please enter the last 4 digits of the credit/debit card that you used to sign up.
Please select your t-shirt size. Men's/Women's XS-4XL shirts are NextLevel Brand 60/40 blend shirts with a slightly slim fit. Men's 5XL and 6XL shirts are Hane's Brand 100% Cotton with a standard fit. PLEASE NOTE WILL WE BE UNABLE TO ACCOMMODATE CHANGES IN SIZES AFTER THIS FORM IS SUBMITTED.
Certification *
One more thing... Please select your division:
Agent Last Year *
Were you an Agent last year? Don't lie......