THE LIST by KP
Each month, one individual will be selected to collaborate with KP Aesthetics & Wellness. This is more than a complimentary treatment—it's an opportunity to share your story, document your experience, and inspire confidence in others.
Full Name
*
First Name
Last Name
Instagram or Social Media Handle
*
What does your audience like most about your content?
*
Email Address
example@example.com
Will you record your entire appointment and share it with your audience?
*
Yes, I will record and share the full appointment.
I will share highlights or clips only.
No, I do not plan to record or share the appointment.
Date of Birth
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
0
01
011
0111
01111
Year
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
City, State
Social Media
Instagram Username
TikTok Username (if applicable)
Facebook Profile (optional)
Are your social media accounts public?
Yes
No
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Approximate Combined Following
Tell me about yourself:
Why do you want to be selected?
What makes your story unique?
Treatment Interest
lip filler
neurotoxin
facial balancing
cheek filler
sculptra
radiesse
miconeedling
prp
iv therapy
provider recommendations
Other
Why are you interested in that treatment?
Have you collaborated with brands before?
Yes
No
Are you comfortable being photographed and filmed?
Yes
No
Are you comfortable speaking on camera?
Love it
Comfortable
A little nervous
I'd rather stay behind the camera
What type of content do you enjoy creating?
TikTok
Instagram Reels
Instagram Stories
Lifestyle
Beauty
Wellness
Educational
Photography
Other
If selected, are you willing to:
Create the agreed-upon content
Tag KP Aesthetics & Wellness
Allow KP Aesthetics & Wellness to repost your content
Complete the collaboration within the required timeframe
Disclose that the treatment was provided as part of a promotional collaboration
Describe yourself in three words:
What's your coffee order?
Favorite way to spend a Saturday?
What's one goal you're currently working toward?
Finish this sentence: Confidence to me means...
If you were selected for The List by KP, what would this experience mean to you?
Anything else you'd like me to know?
Submit
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