M.I. Hope INC Ambassador Registration Form

M.I. Hope INC Ambassador Registration Form

Complete the form below to sign up for our membership service.
Name

First NameLast Name
E-mail
Phone Number:

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date:

MonthDayYear
Where did you hear about us?

A Friend or colleaugeGoogleBlog PostNews Article
Membership Rules
1. Membership is available to anyone 18 years of age or older. 2. You promise NOT to use this opportunity to conduct any fraudulent business activity.
I have read, understood, and accepted the rules for membership.
Please indicate the Type of Position within MI Hope INC that you are most suited:
What position will you fill?*

Governing Member: with a major interest inHealthFarmingIndustryBasic Research relating to the use of KELEA Activated Water.Sustaining Member: I am willing to support MI Hope with a charitable contribution via its PayPal accountPublic Member : I would like to be notified of clinical trials relating to improvements in overall emotional wellness or to clinical trials that are targeting specific illnesses (Please specify the illness's via email to MiHope@MiHopeINC.org)Student, wishing to learn more about KELEA and the ACE pathway and its sponsored products, including Full Victory H2O Beverage.My specific contributions can include: (Please specify via email to MiHope@MiHopeINC.org)A Brand or company interested in Private Labeling or testing or adding KELEA to your product/label or brandOther
Once you submit your application, we will contact you shortly to complete your membership application. Thank you!
The following categories are required for all Brands and Products. Are you a brand or product owner seeking to cross promote, using our labels, or collaborating on a project or event with MI Hope INC?

YesNoNot SureNot yet but working on becoming a brand
All Applicants must show proof of age 18 or older. Please upload a current government issued photo ID! If you answered “yes” or “not yet” to the above question please upload a current government issued photo ID or Business License Copy

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Disclaimer: Herein this agreement, is enclosed a NDA which all applicable members must adhere to as it pertains to their role at MI Hope INC. Some information contained may not directly apply to you but we must protect our intellectual property in the event you do decide to work more in depth with MI Hope INC. All Applicants must sign!
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M.I. Hope INC Ambassador Registration Form

Membership Rules

Please indicate the Type of Position within MI Hope INC that you are most suited: