Brand Ambassador Influencer Form

Brand Ambassador Influencer Form

Join our new brand ambassador influencer program to make some extra money and receive free products. Please fill out form completely to be considered for future campaigns.
Name

First NameLast Name
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
Please include a short bio about yourself. Do not include your full name or contact info or links to outside sources.
Gender?

MaleFemale
Which age group describes you?

18 - 2121 - 3031- 4041 - 5051- 6060+
Questions For CEA Brand Ambassador Influencer Program
Please include at least 1 social media link to be considered. Please ensure your link is not cut off and linked properly.
Social Media platforms you are active on.

InstagramFacebookTik ToKSnap ChatTwitter
Instagram
Facebook
Tik Tok
Snap Chat
Twitter
Geographic location?

CitySuburbRural
Level of education completed?

Highschool DegreeSome CollegeBachelorsMastersNone of the above
Are you currently a student?

YesNo
Occupation
Do you have children?

YesNo
How likely are you to review a brand you have tried?

NeverSomewhat LikelyLikely
Rates you will accept per post? (You may select multiple selections)

$10-$20$20-$30$30-$40$40-$50$50-$100$100+ Only
How often do you post on social media?

DailyMultiple times per weekBi-weeklyMonthly
Note: You may leave the fields below empty if you do not use the platform.
How many followers do you have On Instagram?
How many people are you following Instagram?
How many friends do you have on Facebook?
How many followers do you have on Twitter?
How many followers do you have on Tik Tok?
How many followers do you have on Snapchat?
Income level

Less than $30,000$30,000 - $49,000$50,000 - $74,999$75,000+Prefer not to say
Interests (Please select multiple options)

BeautyShoppingFitnessBusinessFashionToysMusicThings for kidsKid activitiesGamingMeal PrepDiet TipsWork Out TipsVideo TutorialsMakeupSkin CareCelebritiesReal EstateCharitiesBloggingMoviesTravelCookingEducationActivismOutdoor ActivitiesFoodEventsTelevision
Please take a screenshot of a recent post from your Instagram page and it's engagement.

Browse Files

Cancelof
Please take a screenshot of a recent post from your Instagram story and it's engagement.

Browse Files

Cancelof
Share a screen shot or stats from another social media platform in which you feel you have strong engagement.
Add Photo

Browse Files

Cancelof
Add Photo

Browse Files

Cancelof
Add Photo

Browse Files

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Please note the more information we have from you the more likely we are to submit you for campaigns. Thank you for taking the time to complete this form.
This information will be shared with CEA clients and potential clients and any CEA platforms for collaboration purposes.
Do you agree to the terms above?

YesNo
Hope to work with you soon!
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