Influencer Request Form

Please provide your name*

First NameLast Name

Email*

example@example.com

Please select all applicable social media handles*

For each social media platform you selected, please provide the handle name*

e.g. Instagram - @shedd_aquarium

Number of followers on your main social media account*

What is the primary platform you use?*

Are you local to Chicago?*

YesNo

Please provide a description of the theme on your platform/channel*

0/300

What is your audience type?*