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Become an
Emerge Ambassador

Emerge Weight Loss Alt. Logo
Emerge Weight Loss Alt. Logo

This form is invite-only and helps us match you to the right partnership path.

Ambassador Qualification Form

Section 1: Basic Information

State

Section 2: Program Eligibility

Are you currently on a GLP-1 with Emerge?
Yes
No
Have you previously used GLP-1 medication?
Yes
No
Are you willing to commit to a minimum of 90 days if accepted as an Ambassador?
Yes
No
What best describes what you’re looking for?
Emerge Ambassador (active GLP-1 patient with Emerge)
Emerge Affiliate (referral-only, no medication)
I am a content creator seeking paid collaborations

Section 3: Social Media Presence

Primary Social Media Platform

Please include @username or profile links

Approximate Follower Count (Primary Platform)
Do you currently create content related to wellness, fitness, or GLP-1 education?

Section 4: About You

Are you currently partnered with another GLP-1 provider?

Section 6: Final Acknowledgement


I understand that:

  • Ambassadorship is performance-based

  • Sponsorship or comp is earned, not guaranteed

  • Acceptance is reviewed and approved by the Emerge team

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