1.First and Last Name

2.Email Address

3.Instagram handle / link

4.How many followers do you have on Instagram?

5.What is your Facebook name / link?

6.Any other social network?

7.Are you able to post on Instagram about Purple Feather once a week?

Yes

No

8.Are you able to do this for at least 1 month?

Yes

No

9.Where do you live? (City, State)

10.Comments / Anything you would like to add about yourself?