MIRROR PBP – Collaborator Application Questionnaire

Thank you for your interest in joining MIRROR PBP as a Contributor, Practitioner, or Collaborator! Please complete the following questionnaire to help us assess your expertise, alignment with our mission, and potential contributions to our platform.

MIRROR PBP - BRC Event Management Services LLC

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Section 1: Personal Information

Use to set up Profile OR Sending link to pay for product and complete profile
Are you willing to follow and engage with MIRROR’s social media pages?

Section 2: Professional Background & Expertise

What is your primary area of expertise? (Check all that apply):
Have you previously conducted online or in-person trainings, workshops, or courses?
Max. file size: 128 MB.

Contribution to MIRROR (SKIP TO ONLY PRACTITIONER DIRECTORY)

Practitioner Directory annual membership: $250.00

How do you envision contributing to the MIRROR platform? (Check all that apply)
Do you currently have existing courses, programs, or digital content that could be integrated into MIRROR?
Are you willing to actively promote your courses and services through your own networks, in alignment with MIRROR’s promotional requirements?

For U.S. Residents: Payments will be processed via direct deposit or PayPal on a quarterly basis (every 3 months). U.S. contributors must provide a completed W-9 form to receive payments.

For International Contributors: Payments will be processed via PayPal or wire transfer. International contributors may be subject to additional processing fees and currency exchange rates, which will be deducted from the payout amount. A W-8BEN form is required for compliance with U.S. tax regulations.

Payment Distribution for Contributors:

Do you have experience managing refunds, chargebacks, or customer service for your services?
Are you open to feedback and collaboration to align your offerings with MIRROR’s mission?

Section 5: Legal & Compliance

Do you agree to abide by MIRROR’s Terms of Service and Collaborator Agreement?
Have you ever been involved in legal disputes related to your professional work?
Are you HIPAA-compliant and committed to protecting client confidentiality?
Do you have professional liability insurance (if applicable)?
Final Section: Additional Comments

Signature & Agreement

By submitting this application, I certify that the information provided is accurate and truthful to the best of my knowledge. I agree to adhere to MIRROR’s guidelines, policies, and ethical standards.
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