Your Name

Your Email

Phone Number

Address

Have you used CBD before?
YesNo

Did you try any of Dr. Peace Lily products? If so, which ones?

Why do you want to be a brand ambassador for us?

Which social media platforms do you use and what are your handles?

How do you plan to educate your audience about CBD and promote it?

Preferred Promo Code you want your audience to use for discounts when shopping