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©2019 Putting Health at the Top Pty Ltd Independent Modere Social Marketer LEGAL

©2019 Putting Health at the Top Pty Ltd
Independent Modere Social Marketer
LEGAL

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Chinese (Simplified)

Name*
First Last
Facebook Name*
Email in Registration*
Upline / Sponsor*
Promo Code*
Highest Title & Promoter Rank*
Comments*

Step 1 of 3

33%

Name*
First Surname
Preferred Name
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Email*
Enter Email Confirm Email

Occupations (Current or Previous)*
Interests, Skills, Hobbies
Language/s spoken (other than English):
Have you ever done volunteer work?*
If Yes, please give details:*
What type of volunteer work would you like to do? (Please check below)*
- Select All
- Admin for an Official PH@TT Group
- Coordination of events
- Supporting ad hoc activities
- Wizard
- WiT
- Tiger
- Fairy
- Hobbit
- Pixie
- Jedi
How much time can you give?*
Available time/s and days*

Do you have a pre-existing medical condition that the managers and other staff of Ph@tt might need to know about*
Referee #1*
Name Phone Email
Referee #2*
Name Phone Email
I consent to Ph@tt contacting my referees*
- Agree
Date
I confirm that to all details provided in my application is true and the information I have provided will be used for Volunteer role/s within Ph@tt.*
- Agree

Name*
Full Name
Email*
Name on Facebook*
Phone Number*
Country of Residence*
Are you a current mentee on the program?*
- Yes
- No
Are you happy to become a part of Ph@tt in the same team as your current Mentor?*
- Yes
- No
Please provide your Mentors facebook name*
Privacy Policy*
- I have read and agree to the Privacy Policy

Step 1 of 2

50%

Select which option applies*
- Customer
- Mentor
Name*
First Last
Email*
Enter Email Confirm Email
Mentor's FULL Name*

Hypertension • Stroke • Diabetes • Breastfeeding • Pregnant • Heart Condition • Allergies • Medication • Other Illnesses
Are you currently experiencing any of the above conditions?*
- Yes
- No
Please check any that apply or have applied in the past 12 months?*
- Hypertension
- Stroke
- Diabetes
- Breastfeeding
- Pregnant
- Heart Condition
- Allergies
- Medication
- Other
Please provide medication details
Please provide details of other conditions
I have read and understood the questions above, and acknowledge that is it my responsibility to get approval from my Healthcare Practitioner before commencing the PHATT program, or taking any of the supplements.
Content on this site is provided for general information only, and should not be treated as a substitute for the medical advice of your own Doctor or any other health care professional. If you are at all concerned about any side-effects you feel you may be experiencing, always consult your own Doctor or any other health care professional.
SENSITIVE INFORMATION & PRIVACY POLICY*
- I have read and understood the Privacy Policy and the details outlined in the collection of Health/Sensitive information, I have provided

Stallholder Application

Only one Ph@tt stand will be approved for any one event – so it is a ‘first in’ type scenario.
Applicant Name*
Promo Code*
Applicant Email*
Enter Email Confirm Email
Contact Phone Number
Name of Attending D1 or above*
Event Details
Name of Event*
Location*
Date of Event*
Time of Event*
Requirements
Before Ph@tt grants approval, the Social Marketer must comply with this document and provide the necessary information, as required about the specific event.*
- Select All
- A Director 1 (D1) or above needs to be in attendance at all times.
- Your display needs to be professional and in sync with Ph@tt Branding Policy.
- Ph@tt branded clothing is desired (but not compulsory).
- Avoid making any therapeutic claims and adhere to the information as provided on www.puttinghealthatthetop.com
- Ensure you follow up on any leads generated from the event diligently and professionally, as per HL track back rule.
- Ensure you have your own liability insurance
I, the above-named Applicant understands all the requirements set out above and agrees that all requirements are met.*
- Yes

Name of SM Requesting Removal*
Name of SM Removed*
Email of SM Removed
Facebook Name of SM Removed*
Reason for Removal:*
- Did not renew membership
- Investigation
Email*
Enter Email Confirm Email
Date

The following is to be completed by the person requesting to advertise in Healthy Living Secret Facebook group
Name of Applicant*
Facebook Name*
What would you like to be advertised within the Healthy Living Facebook group?*
For what purpose is this for?*
(EG: Phatt Merchandise currently out of stock, sizing not suitable.)
I have read and understood the Healthy Living Policy set out in the Policies & Procedures Manual:*
- Agree
Email*
Enter Email Confirm Email
Date

The following is to be completed by the person requesting to use the Phatt Logo on Merchandise other than merchandise purchased via the website to Putting Health at the Top Management team.
Name of Applicant*
Facebook Name*
What would you like the Phatt logo to be displayed on?*
For what purpose is this for?*
(EG: Phatt Merchandise currently out of stock, sizing not suitable.)
I have read and understood the Branding Policy set out in the Policies & Procedures Manual:*
- Agree
Email*
Enter Email Confirm Email
Date

Name of Applicant*
Facebook Name*
What would you like to use Ph@tt Branding on?*
For what purpose is this for?*
I have read and understood the Branding Policy set out in the Policies & Procedures Manual:*
- Agree
Email*
Enter Email Confirm Email
Date

Please contact your mentor for assistance

or

Ask in the Official Healthy Living group to locate your mentor

Step 1 of 2

50%

Name*
First Name Last Name
Email Address*
Name on Facebook
Phone Number*
Country of Residence*

Who did you hear about the PHATT program through?
Are you currently in touch with a PHATT mentor?
if "yes"...who?
Message
Privacy Policy
- I have read and agree to the Privacy Policy
Phone
This field is for validation purposes and should be left unchanged.

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