Synereo.cc Bounty Declaration Form
Please fill out this form with care if you want to receive your bounty from the Monthly Award Matrix (https://docs.google.com/spreadsheets/d/1Bvrw-oLv6v27eSFhipxos_W580QX9lxJPgpdIVUMt_I/edit?usp=sharing).

Which month are you filling the form out for? *
What is your @slackname? *
Your answer
What is your Slack email address?
Your answer
What is the AMP amount to be received?
As listed in the Monthly Award Matrix.
Your answer
What is your AMP receive address?
Your answer
What is the Divvy amount to be received?
As listed in the Monthly Award Matrix.
Your answer
What is your Ethereum Morden Testnet address?
To receive Divvy.
Your answer
What is the Cryptoindex amount be received?
As listed in the Monthly Award Matrix.
Your answer
What is your Cryptoindex receive address?
Your answer
Do you want to give any comment or further info?
Your answer
Submit
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