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Be An Ambassador

PerfectShaker Ambassador Form

Hello! We are very excited you decided to submit your application and are very interested in getting to know you a bit better.
* Required
First Name *
Last Name *
Email Address *
Address *
(Where product and payment could be sent)
Address Line 2
(Don't forget your unit number)
City *
State / Province *
Postal Code / ZIP *
Phone Number *
Date of Birth *
Sex *
Twitter Profile
Twitter Followers
Facebook Likes
Instagram Account
Instagram Followers
Blog Name
Blog Website Address
Unique Monthly Visits to Blog
Youtube Subscribers
Do you have an inspiring story to tell?: (max 150 words)
What are your personal/health/fitness goals for the next year: (max 150 words) *
Why do you feel you would make a great PerfectShaker Ambassador?: (max 150 word)
In what way(s) will you represent PerfectShaker? Where could you feature the PerfectShaker brand?: (max 150 words)
Are you open to a product rate sponsorship if that is available?