Request edit access
GEMERA Telegram Campaign
Bitcointalk Username *
Bitcointalk Profile URL *
Telegram @username *
Proof of Authentication Post Link *
If you don't provide a valid bitcointalk proof of authentication post link, you won't be accepted.
ETH Address *
Your ETH address has to be ERC20 compatible.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report