Tell us a bit about yourself!
Let's begin!
 
Enter your wonder-FULL NAME here: *

 
Any preferred NICKNAME?

 
What’s the best number to call or text you? *

 
What’s your place of residence? City, please: *

 
And now, State: *

 
We want to get an idea of how much time you have available.
Are you currently… *


 
Where are you currently working?

 
What days & times are you most available each week?

 
Which best describes you: *


 
Do you teach dance/dance fitness classes regularly? If so, how often? *

 
What styles/types of dance fitness?

 
What motivates you the most in fitness? *

 
What motivates you the most in life? *

 
What song makes you move the most? *

 
Where do you see yourself in 5 years? *

 
What do you love to do? Favorite hobbies? Favorite ways to workout? *

 
Are you affiliated with any organizations/clubs?

 
Are you on Social Media?

 
Instagram:

 
Twitter:

 
Facebook:

 
YouTube:

 
Pinterest:

 
LinkedIn

 
LAST STEP, almost done

 
How did you hear about this opportunity? *

 
What is your Superhero or Diva name? *

 
We want to get to know you better. Upload a brief introduction video that addresses the following:
(no more than 5 mins)

1. Why will you make a great SUPERCHARGED Igniter?
- Make sure to include your Superhero / Diva name.

2. What do you hope to take away from the program?
Tell us about your fitness journey. What are your goals? What is your motivation?
 
Video Upload

 
Or ... a Link to the Video

(YouTube, Vimeo, Dropbox, Google Drive, etc.)
 
How do see yourself igniting the lives of others? Please pick which one is the most YOU.





 
Acknowledgment
I certify that all statements are true and complete to the best of my knowledge and that I have withheld nothing that would, if disclosed, affect this application unfavorably. SUPERCHARGED and IEG Media are authorized to investigate said statements. Any misrepresentation or omission will cause either refusal to hire or discharge whenever discovered.
*

The following additional terms and conditions ("Additional Terms") apply to the above invited submission, including any stories, ideas, suggestions, essays, audio, video, photographs or related materials and any other materials of any kind whatsoever submitted (hereinafter, "Invited Submission"). Invited Submissions are also subject to the following terms of SUPERCHARGED and IEG Media, including Innovation Entertainment, iamsupercharged.com and any of their affiliated, parent or subsidiary companies, entities or websites (collectively, "SUPERCHARGED"). By providing the information above and clicking the "Submit" button below you warrant as follows: (1) You are at least 21 years old; (2) Your Invited Submission consists of original material as to which you have the rights and which is true and accurate; (3) Your Invited Submission does not violate the rights of any third party, including, without limitation, copyright, trademark, patent, privacy, or any rights creating claims for idea misappropriation or the right of publicity; (4) Your Invited Submission does not contain any material that is abusive, vulgar, threatening, harassing, libelous, defamatory, obscene or that is known to be false; and (5) Your Invited Submission does not include any private or personally identifiable information regarding any third party, including the name of an individual in combination with his or her social security number, driver's license number, account or credit card number, medical or health information or health insurance information. By providing the information above and clicking the "Submit" button below you also acknowledge and agree as follows: (1) You consent to your name and geographic location possibly being published in connection with the publication, distribution and/or broadcast of your Invited Submission; (2) Your Invited Submissions will not be returned or kept confidential; (3) SUPERCHARGED is not obligated to use or pay you for your Invited Submission; (4) Your Invited Submission becomes the exclusive property of SUPERCHARGED and SUPERCHARGED shall exclusively own all known or later existing rights in the Invited Submissions worldwide; (5) SUPERCHARGED may broadcast or otherwise publish your Invited Submission in perpetuity in all markets worldwide and in all media now known or hereafter discovered, including on www.iamsupercharged.com and in any publication or website operated by SUPERCHARGED or it’s affiliated companies, without any compensation to you; (6) Your Invited Submissions may be shared with SUPERCHARGED’s producers, developers, staff and third parties; (7) Neither SUPERCHARGED nor any third party with whom SUPERCHARGED shares your Invited Submission shall be liable for any use or disclosure of any information included in your Invited Submission; (8) Your Invited Submission may be edited for length, clarity and/or functionality; (9) Submissions similar to your Invited Submission may be submitted to SUPERCHARGED by multiple sources and your Invited Submission may be similar to ideas generated or developed independently by SUPERCHARGED staff and employees; (10) Your Invited Submission may be shared with legal authorities if SUPERCHARGED believes it is warranted or pursuant to a verified request; and (11) SUPERCHARGED reserves the right to change due dates and other specifics for Invited Submissions as it deems necessary in its sole and exclusive discretion. BY CLICKING "SUBMIT" BELOW, YOU HEREBY AGREE TO ALL OF THE ABOVE TERMS AND CONDITIONS.
The following additional terms and conditions ("Additional Terms") apply to the above invited submission, including any stories, ideas, suggestions, essays, audio, video, photographs or related materials and any other materials of any kind whatsoever submitted (hereinafter, "Invited Submission"). Invited Submissions are also subject to the following terms of SUPERCHARGED and IEG Media, including Innovation Entertainment, iamsupercharged.com and any of their affiliated, parent or subsidiary companies, entities or websites (collectively, "SUPERCHARGED"). By providing the information above and clicking the "Submit" button below you warrant as follows: (1) You are at least 21 years old; (2) Your Invited Submission consists of original material as to which you have the rights and which is true and accurate; (3) Your Invited Submission does not violate the rights of any third party, including, without limitation, copyright, trademark, patent, privacy, or any rights creating claims for idea misappropriation or the right of publicity; (4) Your Invited Submission does not contain any material that is abusive, vulgar, threatening, harassing, libelous, defamatory, obscene or that is known to be false; and (5) Your Invited Submission does not include any private or personally identifiable information regarding any third party, including the name of an individual in combination with his or her social security number, driver's license number, account or credit card number, medical or health information or health insurance information. By providing the information above and clicking the "Submit" button below you also acknowledge and agree as follows: (1) You consent to your name and geographic location possibly being published in connection with the publication, distribution and/or broadcast of your Invited Submission; (2) Your Invited Submissions will not be returned or kept confidential; (3) SUPERCHARGED is not obligated to use or pay you for your Invited Submission; (4) Your Invited Submission becomes the exclusive property of SUPERCHARGED and SUPERCHARGED shall exclusively own all known or later existing rights in the Invited Submissions worldwide; (5) SUPERCHARGED may broadcast or otherwise publish your Invited Submission in perpetuity in all markets worldwide and in all media now known or hereafter discovered, including on www.iamsupercharged.com and in any publication or website operated by SUPERCHARGED or it’s affiliated companies, without any compensation to you; (6) Your Invited Submissions may be shared with SUPERCHARGED’s producers, developers, staff and third parties; (7) Neither SUPERCHARGED nor any third party with whom SUPERCHARGED shares your Invited Submission shall be liable for any use or disclosure of any information included in your Invited Submission; (8) Your Invited Submission may be edited for length, clarity and/or functionality; (9) Submissions similar to your Invited Submission may be submitted to SUPERCHARGED by multiple sources and your Invited Submission may be similar to ideas generated or developed independently by SUPERCHARGED staff and employees; (10) Your Invited Submission may be shared with legal authorities if SUPERCHARGED believes it is warranted or pursuant to a verified request; and (11) SUPERCHARGED reserves the right to change due dates and other specifics for Invited Submissions as it deems necessary in its sole and exclusive discretion. BY CLICKING "SUBMIT" BELOW, YOU HEREBY AGREE TO ALL OF THE ABOVE TERMS AND CONDITIONS.
     
Thank you so much!
We'll be in touch soon.
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