Full Name *

Email *

Phone *

1. What is your individual role and/or interests, and is there anyone else who is in official capacity to influence this Affiliate partnership? *

2. Do you have a bio, physical or virtual store, website, professional license within a holistic discipline, and/or social media channels/followers? Please list and/or share. *

3. Please share (if any) your background or specialty in one or more of the following: - Greater Wellness - Bioenergetic Healing & Therapy - Chronic Disease, such as Lyme and coinfections. *

4. As our Affiliate partner, what are your short and/or long-term business goals to help accelerate sales with us? *

5. What forms of promotions would you undertake in the first four months with us, and how many interested clients do you foresee reaching? *

6. Do you have a vision on how you can make your Affiliate partnership for NIKKI sustainable, by building a continual revenue stream over one year? *

7. Are you looking to take on a strong leadership role in becoming a NIKKI Referrer, by further educating and promoting the wearable to your clientele and/or community? If so, explain how. *

8. Are you considering selling NIKKI in person within a clinic, store, trade/consumer show, conference, event etc? *

9. Are you currently an Affiliate Referrer of other products and/or services? Please list. *

10. What other cross promotional opportunities might be available to strengthen your Affiliate partnership for NIKKI. ie. Podcast interviews, R&D, Events, White Labels, Sponsorships etc. *

11. Is there a specific coupon code or promoter ID you would like to use? *

Were you referred to us by another affiliate? If so, please provide their name here.

Please let us know which, if any of these devices you currently own and use.

Wave 1

NIKKI

NIKKI +Lyme

Whoop

Oura

FitBit

Other Smartwatch

Hapbee

Muse

Apollo Neuro

Other Wearable Tech

Select all that apply

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business. I further agree to abide by all terms and conditions of my affiliate agreement should I be approved.

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