Flossly Ambassador Onboarding Form

Personal Information

First Name *

First name is required

Last Name *

Last name is required

Email Address *

Valid email is required

Phone Number *

Valid phone number is required

Address *

Address is required

City *

City is required

Postcode *

Postcode is required

Date of Birth *

Date of birth is required

Nationality *

Nationality is required

Professional Background

Current Role in Dentistry *

Please select your role

Years of Experience in Dentistry *

Years of experience is required

Current Practice / Workplace *

Practice name or company name

Workplace is required

Qualifications & Credentials *

NVQ / Level 3 Qualified

Degree / Diploma Holder

GDC Registered

Mentor / Trainer Experience

Other (please specify below)

Please select at least one qualification

Other Qualifications (if applicable)

Estimated Audience Size *

Please select your audience size

Social Media Presence *

Share your social media handles so we can verify and support you

LinkedIn Profile URL

Instagram Handle

Facebook Profile / Page

Twitter / X Handle

TikTok Handle

Why Do You Want to Become a Flossly Ambassador? *

Minimum 50 characters. Be authentic!

Please tell us why you want to be an ambassador (at least 50 characters)

How Do You Plan to Contribute? *

Podcast appearances

Host webinars/training

Social media promotion

Direct referrals

Host networking events

Mentoring & coaching

Please select at least one way you'll contribute

Hours per Week Available *

Please select your availability

Banking & Payment Details

🔒 Your banking information is encrypted and stored securely. We use this solely for monthly £300 stipend payments.

Account Holder Name *

This must match your bank account exactly

Account holder name is required

Sort Code *

Format: 12-34-56

Valid sort code is required

Account Number *

8-digit account number

Valid account number is required

Account Type *

Please select account type

Bank Name *

Bank name is required

IBAN (Optional - for international transfers)

Only needed if you have an international account

✓ You'll receive £300 on the last business day of each month

✓ Your banking details are encrypted and secure

✓ You'll receive a payment confirmation email each month

I confirm that the above banking details are correct and match my bank account *

You must confirm your banking details

I understand that £300 monthly payments may be subject to UK tax requirements and I'm responsible for reporting this income *

You must confirm tax responsibility

Confirmation & Agreement

Summary

✓ Name: -

✓ Email: -

✓ Role: -

✓ Monthly Stipend: £300

✓ Payment Method: Bank Transfer

Ambassador Agreement *

I understand this is a community-driven role, not a sales position, and I commit to acting as an authentic brand advocate *

I commit to contributing meaningful content and activities monthly as outlined in the 12-month plan *

I understand that I'm expected to help generate £300+/month in revenue to sustain this partnership *

I will clearly disclose my ambassador relationship in all Flossly-related content and promotional posts *

I consent to Flossly using my contact information for onboarding and monthly payment processing *

I agree to represent Flossly professionally and maintain ethical standards in all communications *

You must accept all terms to proceed

I have read and agree to all terms and conditions above *

You must confirm to submit

Flossly Ambassador Program

Thank You!

Personal Information

Professional Background

Banking & Payment Details

Confirmation & Agreement

Summary