myPelvicBra Affiliate Program Application
By joining our affiliate program, you'll have the opportunity to earn commission by promoting myPelvicBra products to your audience and helping to improve pelvic health worldwide.
First Name
Last name
Email
Phone Number
Type of Applicant
Influencer
Pelvic Health Provider
Both
Please tell us about yourself and why you would like to participate in our affiliate program:
Do you currently recommend external perineal support options?
Yes
No
If yes, what do you typically recommend them?
Pelvic organ prolapse
Perineal descent (hiatal ballooning)
Urethral hypermobility
Urinary incontinence
Anal incontinence (stool and/or gas)
Other (Please specify below)
Menstrual cycle heaviness
Postpartum heaviness
Pregnancy heaviness
N/A
Other
What improvements would you like to see in the current external perineal support space?
Affiliation Details:
If you are an influencer, please provide links to your social media profiles or website/blog:
Social Media Handle 1:
Social Media Handle 2:
Are you willing to demo the pelvicbra on social media 2-3x a month? (including grid posts, reels and stories)
Yes
No
Website/Blog URL:
Are you willing to provide feedback on how we can improve the pelvic bra?
What is your preferred way to connect?
Social Media DM
Email
If you are a pelvic health provider, please indicate your preference: (please note both options come with a free sample and a unique 10% discount code to share with your community)
Affiliate - Receive a sample, earn a 10% of sales, and track sales/stats online via portal login
Clinic Sample Only - Receive a sample, 10% unique patient discount code, but no commission or login
Location
Are you based in the United States?
Yes
No
If no, where are you located?
What size would you prefer for your sample? Please note that samples are based on inventory, and we will do our best to provide your preferred size. However, availability may vary, and we may not always be able to fulfill your exact request.
XXS
XS
Small
Medium
Large
X-Large
XXL
XXXL
Address
Would you like to be a prototype tester as we continue to design new pelvic support resources?
Yes
No
If yes, what is your typical panty size?
Would you like to receive physical brochures to hand out to your community?
Yes
No
Once approved, you will receive a one time code that lets you order a sports pelvic bra for 100% off. Unfortunately, our system doesn’t allow free shipping plus a coupon code. It will ask you to pay for shipping. We are willing to reimburse you for the fees you pay in shipping. Please email hello@mypelvicbra.shop to be reimbursed for your shipping fees.
If you requested brochures, they will be included in your shipment when you place your sample order.
Additional Comments/Questions:
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