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Media Influencer Contact Form
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First Name
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Last Name
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Preferred Pronouns
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Country of Residence
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Email Address
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Website URL
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Primary Social Media Channel (Instagram, Facebook, Twitter, etc.)
Instagram
Facebook
Blog
Twitter
Other:
Primary Channel URL
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Total Followers or Subscribers
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Average Engagement per Post
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Blog Views (per month)
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Do you follow and engage with us on our social channels currently?
Follow and engage
Follow only
Don't follow currently
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Please share URLs to any relevant examples of past coverage/prior collaborations:
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Are you seeking payment for collaborations?
Yes
No
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Describe payment requirements, desired budget range and whether some or all are negotiable.
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Comments Section - Anything else you'd like to add to your request?
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