ICF Get Ahead of Sepsis Campaign Blog Tour Sign Up Form
Please include only the accounts information you will use to participate in and promote this campaign. We use this information to make influencer recommendations and selections and share with the brand. You will be required to promote using the accounts you share in this application form should you be selected and agree to participate in this campaign.
First Name *
Last Name *
Email Address *
Blog Name *
Blog URL *
Average Monthly USERS (not page views) to Your Blog per Google Analytics *
Please share the "User" number in Google Analytics. NOT the "pageview" or "sessions" number.
Street Address *
City *
State *
Zip Code *
Phone Number *
What is your age? *
What is your gender?
What primary blog topics do you write on (top three)? *
Do you consider yourself a parenting, caregiver, healthy aging, health/wellness, Latina, or African American blogger? Please explain.
Are you an influencer in a niche that would be a natural fit for discussing sepsis topics (e.g., infection prevention, vaccination, caregiving, parenting, health/wellness, management of chronic conditions, healthy aging)? Please explain. *
I am:
Clear selection
I am:
Clear selection
Have you NEVER promoted/do not promote products that have not been cleared by the U.S. Food and Drug Administration (FDA)? 
Clear selection
Do you have a clean aesthetic on your website (beautiful pics, low ratio of sponsored to non sponsored posts)?
Clear selection
Do you believe in the CDC’s mission and role in America’s public health realm? [CDC mission page: https://www.cdc.gov/about/organization/mission.htm]
Clear selection
Are you a caregiver? Please explain.
Are you willing to write a 300-word (minimum) posts on the theme provided and share 5 times on your social media accounts? *
Twitter ID
Number of Twitter Followers
Facebook Page URL
Number of Facebook Likes
Pinterest URL
Number of Pinterest Followers
Instagram URL
Number of Instagram Followers
Google+ URL
Number of Google+ Followers
Please share three URLs related to this topic you have published on your site.
Why do you feel you are a good fit for this campaign? We love sharing your personal information with clients, so if you are passionate about this topic, please explain. Thanks!
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This form was created inside of Mom It Forward.