Ambassador Opportunity

Ambassador Opportunity

Apply to Become a Milestone Group, U.A. Ambassador Today!
Today's date*

YearMonthDay
Date
A. Identification (Representative Applicant)
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
E-mail*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
Private Member Applicant Domicile Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
PP Country Code*
PP Number*
PP Date of Issue*

YearMonthDay
Date
PP Date of Expiry*

YearMonthDay
Date
May we send you an email?

YesNo
May we leave a voicemail?

YesNo
May we send you a text?

YesNo

B. Strategic Philanthropist Referral Information
Strategic Philanthropist's Full Name*

First NameLast Name
C. Organization/Company Information

(Skip if not applying as an Organization or Company)
Organization/Company Name
Phone Number

Country CodeArea CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Website URL
Job Title and Duties
How long have you represented this Organization/ Company?
Are you the authorized Principal and Financial Signatory to make final decisions for your Organization/Company?
If Not, please share principal's name and information.
Please list any other information you feel may be relevant.
Significant other/nearest friend or relative not living with you
D. Other Information
Occupation
Licensing / Occupation / Skillsets?
Personal / Organizational Net Worth (EUR/USD)
Date of Application

MonthDayYear
Date
This is a strictly confidential bona fide Ambassador Participant record submitted to complete Relationship and Royalty Sharing Covenant for Private Placement to qualify a Joint Venture between Applicant and Milestone Group, U.A.

Redisclosure or transfer of this information is expressly prohibited by law.
Should be Empty:

A. Identification (Representative Applicant)