Add / Modify subscriber


Add to List* __LISTS__
Source of the Lead
Email *
First Name
Last Name
Address1
Address2
City
State
Country __COUNTRY_LIST__
Phone
ZIP Code
IP Address #
Regn Date $ __RegnDate__
Custom Field# 1
Custom Field# 2
Custom Field# 3
Custom Field# 4
Custom Field# 5
Custom Field# 6
Custom Field# 7
Custom Field# 8
Custom Field# 9
Custom Field# 10
  Send Welcome Message


# If IP Address is not given, this System IP Address will be recorded.
$ If Regn Date is not given, Today's date will be recorded.