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* 1. Contact Information: Please note that you must live in the U.S. to be a part of our Ambassador Program

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* 2. Gender:

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* 3. Birthday:

Date

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* 4. Instagram Handle:

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* 5. Favorite Clio Bar Flavor:

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* 6. How did you discover Clio?

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* 7. Where do you shop for Clio?

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* 8. How many miles away is the closest store to you that carries Clio?

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* 9. What Clio flavors are available in your area?

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* 10. What is your dream Clio flavor?

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* 11. Why do you want to become a Clio Ambassador?

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