Agency Registration Form

If you operate an officially registered au pair or nanny agency, you are invited to register your agency with our
referral service, by completing the form below.
For a free trial period of 30 days, you will receive details of relevant families, au pairs and nannies that have registered their search with us.
After the trial period, if you wish to continue receiving the benefits of registration, you will be required to complete the registration payment form. (See our Terms and Conditions for more details.)

Benefits of registering

Agency name		Contact name
Address (Blg. no., Street)		City/Town/Village
State/County		Zip/Post Code
Email		Country
Telephone		Fax
Official agency registration / reference number		Website URL
This agency places...		Language (for email notifications)
Comments
Please choose a password, to enable you to access your details on-line. (At least 6 characters, and no more than 12 characters. Spaces are not allowed.)
Password		Verify password
I confirm that I have read and understood Azzoomi.com's Disclaimer and, following the free trial period of 30 days, I will either pay the required subscription fee and be bound by Azzoomi.com's Terms and Conditions, or allow my registration to lapse.