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Title |
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First Name: |
* |
Last Name: |
* |
Date of Birth: |
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Gender: |
Male Female |
Marital Status: |
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ID/PASSPORT Number: |
* |
Citizenship/Nationality: |
* |
Country: |
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Postal Address: |
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Postal Code: |
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Business Address: |
Street address: |
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Suburb: |
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Town: |
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Province/State/County: |
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Country: |
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Presently residing in: |
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Mobile/Cell Number: |
Country code: |
Number: * |
Home Telephone: |
Country & area code: |
Number: |
Work Telephone: |
Country & area code: |
Number: |
Skype |
If you have Skype, please enter your Skype ID: |
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E-Mail Address: |
* |
* I have read the Terms and Conditions for TLC-Ambassadors and agree to full compliance as specified.
View Terms and Conditions |
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Facebook Profile and Details/Address (if applicable): |
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Proposed city/area you wish to operate as a TLC-Ambassador in (e.g. City and Country): |
1st Choice: |
* |
2nd Choice: |
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3rd Choice: |
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*Where did you hear about TLC? |
* |
Have you done a TLC-Program? |
Yes No |
Please provide details: |
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Do you need to do a TLC-Program (based on your image/health profile)? |
Yes No * |
Is your Wellbeing-profile Healthy (add any comments)? |
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Do you intend running the business full/part- time? |
Full-time Part-time * |
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Do you have/own an existing business (including own business name and branding) that you would like to add TLC-Programs/Products/Services to? |
Yes No * |
If so, please provide details: |
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Have you ever managed your own business? |
Yes No * |
If so, please provide details: |
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Your Home Language? |
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Can you speak, read and write English? Important Note: The business/operational language of TLC-International, its TL©-Programs and Services are/is in English only. |
Yes No * |
Other languages you can speak, read and write: |
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What is your current occupation/business? Give details: * |
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List your Key Professional and Other Qualifications? Give details: * |
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Although not essential for being a TLC-Ambassador, briefly list any Wellbeing/Health/Medical Industry Experience you may have. Give details: |
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Motivation/General Comments: *
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Thank you for your time. Note: An automated e-mail confirmation of your application will be processed to yourself within 48 hours.
You will be notified via e-mail (within 7 days) whether your application has been successful and the required actions for your formal Registration as a TLC-Ambassador. |