THEKNOWWOMEN Email Marketing -

First Name*

Last Name*

Preferred name (if different from above)

Date of Birth*

Email*

Phone*

Current mailing address*

Location*

How long have you lived in the area?*

Would you consider yourself a local tastemaker or influencer? If so, why?*

Why would you like to bring the KNOW Book + Tribe to your city?*

Have you seen a KNOW publication?*

Yes

No

If so, which one?

What skills would make you a successful KNOW Ambassador? * Please list any advertising, sales, project management, or small business experience.*

Will KNOW Publications be your only occupation? If not, please list any other jobs/responsibilities you will have. **

Please list any preliminary questions that you may have about the KNOW Book + Tribe. **

CERTIFICATION AND CONFIDENTIALITY STATEMENT I authorize the KNOW Tribe, LLC. and its affiliates (collectively “KNOW Publications”) to rely on the information contained in this application and any supplemental information I might later provide in deciding whether to accept me as a KNOW Ambassador. I certify that the information contained herein is true, correct and complete as of the date submitted. In accordance with the Privacy Act, Freedom of Information Act and any similar federal, state or local law or regulation, I expressly authorize any past or present employer, law enforcement agency, educational institution, and any other person who has knowledge of my character, work, business and educational experience, criminal records or other information about me (whether or not contained in this application) to release information to and cooperate with KNOW Publications in conducting such investigation. I release all persons from liability as a result of their release of true and accurate information in connection with KNOW Publications' investigation. I authorize the use of photocopied or faxed copies of my signature to obtain information in connection with KNOW Publications' review and investigation of my application. If I intend to become the KNOW Ambassador with other applicants whom I have identified to KNOW Publications, I authorize KNOW Publications to discuss with such co- applicants any information that might negatively affect its determination to becoming a KNOW Ambassador. I am aware of no facts, circumstances or events (actual or threatened) that I have not disclosed that might make the information contained herein or that I have otherwise provided to KNOW Publications incorrect, incomplete or misleading. I agree to promptly notify KNOW Publications of any material change in any of such information and of any events that might have a material impact on the truth, accuracy or completeness of such information. I understand that KNOW Publications might require additional information in considering my application. I agree to the terms listed in the KNOW Confidentiality Statement.

Yes

No