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New Member Registration



To register for Motorola contactrewards, you have to be a sales staff of a Motorola Distributor selling approved Motorola Two-Way Radios and Accessories from the participating countries.

Complete this registration form with all the required information. Please provide a valid email address as your User ID and password will be send to you via email.

- Fields marked with * are compulsory. Please ensure that all compulsory fields are completed.

You can choose to fax or email your registration form by downloading the PDF version of this form here. To view the form, please download Adobe's free Acrobat Reader by clicking on the Get Acrobat Reader icon.

My personal details
Title: *
First Name: *
Family Name: *
Gender:  
Marital Status:  
Date of Birth:
(Day-Month-Year) 		*
No. of Children:  
Age Range:
Highest Education Level Attained:  
> Annual Household Income:  
Job Title * >
Company Name:
(max 50 characters) 		* >
> I am in the business of selling Two-Way Radios/Walkie-Talkie/Handie Talkie: *
> I am a Motorola: * >
> Preferred Language: *
My contact details
Office Address 1: *
Office Address 2:  
Office Address 3:  
Office Building Name:  
Office State/Province: *
Office City: *
Office Country: *
Office Postal/Zip Code: *
Email:  
Confirm Email:
Office Tel: * - -  
 - e.g. 91-44-6570345 (country code-area code-tel no) (May have a '0' in front of Area Code)
Office Fax: * - -  
e.g. 91-44-6570346 (country code-area code-tel no) (May have a '0' in front of Area Code)
Mobile No:   - -  
e.g. 86-010-90091855 (country code-area code-tel no) (May have a '0' in front of Area Code)
Home Address:
(max 100 characters) 		 
Home Address 2:  
Home Address 3:  
Home Building Name:  
Home State/Province:  
Home City:  
Home Country:  
Home Postal/Zip Code:  

Home Tel:

   - -    
 - e.g. 91-44-6570345 (country code-area code-tel no) (May have a '0' in front of Area Code)
Preferred Means of Receiving Communications: *     
Preferred Mailing Address: *
I acknowledge the above information provided by me is true and correct and to best of my knowledge. I accept that any inaccurate information provided by me may lead to my disqualification from the programme. My participation is completely voluntary and that I shall not hold Motorola responsible for any situations arising directly or indirectly from my participation in the programme. I acknowledge that participation in the programme constitutes acceptance of the terms & conditions of the Motorola contactrewards programme.