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Ambassadorship Application Form
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Name
*
First
Last
Gender
Male
Female
Others
Date of Birth
Email
*
Phone
Country
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Address
Address Line 1
City
— Select state —
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Name of company you work
Your position at work
Name of next of kin
Have you work with us before?
Yes
No
What are some of your talents and/or giftings?
Upload Passport
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Take photo of your full Passport showing the number and your photo
How many countries have you been to?
How many countries have you been to?
Do you have membership card?
Yes
No
Lost
If yes what's your ID number
Identification Number
CHOOSE AN OFFICE
INFLUENCER AMBASSADOR $25000
BRAND AMBASSADOR $50000
EXPERT AMBASSADOR $100000
AFFILIATE AMBASSADOR $250000
SHORT NOTE ABOUT YOURSELF
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