Pro Staff Application Form

Pro Staff Application Form

Please fill out the form below to apply for our Pro Staff Program.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth*

MonthDayYear
Date
Residential Address*

Street Address

Street Address Line 2
CityStateZip Code
Shipping Address if different from Residential Address

Street Address

Street Address Line 2

CityState

Zip Code
What Brands are you interested in representing?*

PowerPuxSecure Outdoors USAShore-Up
Please select all that applies to you.*

Tournament AnglerGuide or Registered CaptainSocial Media InfluencerYouTube InfluencerHigh School or College Fishing Team CoachWeekend Warrior
What other companies do you currently represent?*
Please select all social media platforms you currently use.*

FacebookInstagramTicTocYouTubeX
Facebook

User NameNumber of Followers
Instagram

User NameNumber of Followers
TikTok

User NameNumber of Followers
YouTube

User NameNumber of Followers
X

User NameNumber of Followers
Would you be interested in being part of our Retail Store Visit Program?*

YesNo
Signature*
Date*

MonthDayYear
Date
Should be Empty: