SHINE Ambassador Form
Do you have what it takes? Please fill out the form below so we can invite you into the SHINE Ambassador Program (it's FREE). You get special perks + 15% commission on each ticket sale made through your special affilliate link.
Your Name
*
First Name
Last Name
Your E-mail
*
example@example.com
Do you have a special group of friends that will benefit from attending the conference?
*
Please give us some details about your group.
Can you commit to having at least 10 attend the Leap & SHINE Conference in London?
Yes, I Can - I'm a goal getter
No, I.m Sorry
Will you be available to receive your SHINE Ambassador Certificate of Honor and attend the Afterglow reception?
Yes, For Sure
Err, I'm Not Sure
Choose Your Ambassador Level
*
Glitter Ambassador (at least 10 Referrals with affiliate 15% commision on each ticket sale)
Sparkle Ambassador (at least 20 Referrals with affiliate 15% commission on each ticket sale)
Dazzle Ambassador (at least 40 Refferals with affiliate 15% commission on each ticket sale)
Your Bio or Profile?
*
Please Paste Your Short Bio or Profile for your SHINE! magazine feature.
Your Website or Social Media Link
Upload your high resolution photo (we'll use this for your feature in the magazine)
*
Upload a File
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of
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