Team US Chia Application
Please fill out this form if you are interested in becoming a Representative or Sponsored Rider/Trainer.
How do you identify yourself? (Check all that apply) *
Required
In which sports/disciplines are you involved? (Check all that apply) *
Required
How many total horses do you have/work with? *
Your answer
How many horses would you like to start on US Chia? *
Your answer
Have you fed chia seeds before? *
Tell us a little more about yourself.
Your answer
Are you more interested in promoting or selling US Chia products? *
How did you hear about US Chia? *
Your answer
Name of the individual that referred you:
Your answer
Your First Name *
Your answer
Your Last Name *
Your answer
Email *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Country *
Your answer
Phone Number (with area code) *
Your answer
We will contact you directly to discuss your application. Can we contact you at the phone number above? *
When is the best time to call you? *
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