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* 1. What is your first and last name?

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* 2. What is your email address?

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* 3. What is the city/province that you live in? *please note, we require that our influencers live in and have the ability to work in Canada*

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* 4. Do you work with an influencer agency? If so, please provide their details and contact information. If not, feel free to skip.

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* 5. What is your Instagram handle? If you don't have one, please write N/A.

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* 6. How many followers do you have and what is your total percentage of Canadian followers?

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* 7. What is your Facebook page name? If you don't have one, please write N/A.

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* 8. How many Facebook page likes and followers do you have and what is your total percentage of Canadian followers?

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* 9. What is your YouTube channel name? If you don't have one, please write N/A.

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* 10. How many YouTube subscribers do you have and what is your total percentage of Canadian followers?

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* 11. What is your TikTok user name? If you don't have one, please write N/A.

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* 12. How many TikTok followers do you have and what is your total percentage of Canadian followers?

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* 13. What is your primary target audience? (Please select only one)

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* 14. What is your secondary target audience? (Please select only one)

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* 15. Do you have a media kit you'd like to share with us?

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