Ambassador Request Form Interested in becoming an ambassador for Emerge Medical & Well Spa? Please complete this form and we will be in touch shortly. If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required First Name Last Name Email Phone Instagram Handle City in Oklahoma you live in Type of influencer you are (Beauty/Fashion/Fitness/Wellness, etc) Number of followers you have How long have you been an influencer? Have you ever worked as an influencer for another day or medical spa? If yes, who and when? How did you hear about us? What services are you interested in receiving with us?