CanYa HODLer Club Application Form
You have indicated that you would like to apply for the CanYa HODLer Club.
To join this club, please provide your details and your wallet address for our team to audit your account.

Wallets that do not satisfy these requirements will not be considered.

Email address *
First Name *
Your answer
Last Name *
Your answer
Email Address *
Please reverify your email for us, this is important if it is different from the email we have already captured.
Your answer
What is your Discord username and number?
Please make sure to input you address in the format name#1234.
Your answer
ETH Wallet Public Address *
This is the Wallet that currently contains your CAN Tokens
Your answer
What wallet is this? *
Please tell us where your tokens are stored. Examples, Trust, myetherwallet, Jaxx. Please do not attempt to whitelist an address from an exchange wallet.
Your answer
CAN Token Quantity in Wallet *
Please enter the amount of CanYa Tokens in you ETH wallet
Your answer
Where did you acquire your CanYa Tokens? *
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