Mighty Well - Ambassadors - Get to Know You Form

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Let's start with your name.* This field is required.Introduce yourself using the boxes below
First Name
Last Name
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Let's connect; what's your email address?* This field is required.We'll send you awesome promotions, discount codes, and inspirational content every couple weeks.
example@example.com
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Let's get social; what's your Instagram handle?* This field is required.Example: @mightywell_
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Are you active on other social media channels? Paste the handles and/or links below.* This field is required.If no, please type N/A
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Tell us a little bit about you.* This field is required.
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Can you tell us what your experience has been having a chronic illness?* This field is required.If you yourself don't have a chronic illness, what has your experience been like in the chronic illness community?
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How has your experience been made a little easier by your Friends in the Fight (those who support and help you through your journey)?* This field is required.
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What are some words of inspiration you can give to others who have a chronic illness?* This field is required.
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How have Mighty Well products helped you through your chronic illness journey?* This field is required.
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What would you be interested in being involved in right away?* This field is required.(Select as many as apply)
Day in the Life (Submitting IG story videos showing a "day in your life")
Blog post about you (We would use this form and ask you to provide a few more details as well as photos)
Blog post about something else (Please write your idea in the "Other" section below)
Other
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Share your photos with us!We'd love to feature your story on our social media and/or our blog. Please upload any photos you'd like us to use. Bonus points if you're in Mighty Well products :)
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Max. file size: 10.6MB
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