Ethereum Fire Insurance Facebook Registration form
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Bitcointalk username (  Your bitcointalk.org account username) *
Bitcointalk profile URL (Permalink URL to your profile. Wrong, or ambiguous URLs will immediately disqualify you from the campaign.) *
#PROOF OF REGISTRATION permalink URL  ( URL pointing directly to the message of your proof of registration. Failing to provide this, will result in your disqualification from the bounty campaign.) *
Facebook Profile URL *
Number of Facebook Friends *
Email address  (Email addresses will be hidden, and won't be used for any spam / promotional actions. Emails are to verify users when comparing collected data with projects own data.) *
ERC-20 compatible wallet address *
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