SHENIX® Ambassador Form

First Name*

Last Name*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Job Title

Tell us more about you!

Social Media Channels:

Rows	I use this Social Channels	Username/Handle	Which channels are you on the most?
Facebook
Instagram
Linked In
Tik Tok
Snap Chat
Twitter
YouTube
Reddit

Are we missing any social options that you'd like to add? Please include your social handle.

What do you love about SHENIX®?

How did you hear about SHENIX®?

Share a Video or picture of why you love SHENIX®.

Media Waiver*

I grant permission to SHENIX® to use my name, likeness, and/or voice in any and all media materials including, but not limited to, photographs, videos, and audio recordings. I understand that the media materials may be used for any lawful purpose, including marketing, advertising, and promotion.I waive any right to inspect or approve the finished media materials or any associated promotional materials. I release SHENIX® from any and all claims, demands, or causes of action that I may have against them arising out of or in connection with the use of my name, likeness, and/or voice in the media materials.I acknowledge that I am 18 years of age or older, and that I have read and fully understand this media waiver before signing it.

Email List (We promise we won't spam you.)

Yes! Add me to your list.

Signature*

Date*

Date

Tell us about yourself