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Co-op Ambassador Form
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Mobile Number
*
Your answer
Current Address
*
Street Address, City, Province, Postal Code
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Instagram
Instagram link
Your answer
Facebook
Facebook link
Your answer
TikTok
TikTok Link
Your answer
Twitter
Twitter Link
Your answer
Why are you interested in becoming a Cornerstone Co-op Ambassador?
*
Your answer
How would you promote our brand and our products?
*
Your answer
Which commodity are you most interested in promoting?
*
Food/Pharmacy
Gas Bar/Convenience Store
Home Centre/Agro
Liquor
Bulk Fuel/Cardlock
What makes you unique?
*
Your answer
Co-op Number
*
Your answer
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