Influencer Application Form v2

Complete This Form And We'll Get Back to You

Enter your contact information and we'll respond after within a couple of days. Also, please ensure you're qualified by going over the checklist we included below. The name, email, and photo associated with your Google account will be recorded when you upload files and submit this form Any files that are uploaded will be shared outside of the organization they belong to.
Name*
Mobile Phone *
Email*
example@example.com
Location*
Date Of Birth*

MonthDayYear
Date
Sex*

MaleFemaleOther
Preferred Pronoun*

SheHeThey
Have you had a consultation with an AirSculpt Clinic before?*

YesNo
Do you currently have any areas of concern with looses skin?*

YesNo
Weight and Height
Areas Of Interest*

BackStomachBBLSkin TighteningUp-A-CupArmsChinMale ChestLegsCellulite Removal
Out of all areas chosen which would you consider a priority?*
Have you tried other procedures/alternatives?*

Ozempic/WeGovy/SemiglutideEmSculptCoolSculptKyBellaTraditional LiposuctionOther
Have you done other collaborations with cosmetic surgery?*
When did you get your procedure done?*

MonthDayYear
Date
Brand Deck Upload*

Cancelof
Provide a small paragraph explaining the type of content you create*
Add all applicable social media handles and Links (Instagram, TikTok, Youtube, Facebook, X)*
Drive URL
Intercom URL
Should be Empty:

Complete This Form And We'll Get Back to You