Register – DREAMTouch Agency

If you would like to offer free phones, You Will Need A RAD ID Number To Continue: Get Your RAD By Visiting www.lifelinerad.org And Clicking Register. Please Enter Your New RAD ID In The Box Below: (Skip This section if you do not wish to offer free phones)

Which Program Are You Interested In?*

First Name*

Email*

Password*

Confirm Password*

Last Name*

Phone Number*

Date of Birth*

Social Security Number

Address

Street Address

City

ZIP / Postal Code

State / Province / Region

Country

The DREAMTouch Agent That Referred You?

City And State You Plan To Operate:

Upload a Valid State ID / Drivers License*

Choose File

Upload a photo of you holding a valid ID.

Choose File

Attach a headshot photo to be used for your Badge

Choose File

Did you verify your photos and ID uploads are not blurry and legible?

YESNO

Only fill in if you are not human