Lebert Fitness Ambassador Program

APPLICATION FORM

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* 1. Contact Information

First Name *

Last Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Email Address *

Phone Number *

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* 2. Social Media Handles (Instagram, Facebook, Twitter, YouTube, Pinterest, Snapchat)*

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* 3. In 100 words or less, describe how you embrace and influence the world of fitness and health?

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* 4. How did you hear about Lebert Fitness’s products?

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* 5. Have you used Lebert Fitness products before?

Yes

No

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* 6. If yes, how (example: on your own in a gym, teaching classes/training, home workout)?

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* 7. Do you have an e-newsletter?

Yes

No

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* 8. If yes, how many subscribers do you have?

1-500

501-1000

1000-5000

5000+

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* 9. Do you hold any fitness/health/wellness certifications?

Yes

No

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* 10. If yes, what are they?

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* 11. Are you interested in working with us at live events in your area (summits, demos, etc.)?

Yes

No

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* 12. What’s the BEST way in which you’ll be able to spread the LeLOVE by becoming an ambassador?

100% of survey complete.