Aflac Grammy's Instagram Campaign Sign Up Question Title * 1. Contact Information Name: * Company: * Address 1: * Address 2: City/Town: * State/Province: * ZIP/Postal Code: * Country: * Email Address: * Phone Number: * Question Title * 2. What is your birth date? (ie 02/02/1985) Question Title * 3. What is your Blog URL? Question Title * 4. How many Unique Monthly Visitors? Question Title * 5. How many Facebook Fans do you currently have? Question Title * 6. What is your Facebook URL? Question Title * 7. How many Twitter followers do you have? Question Title * 8. What is your Twitter URL Question Title * 9. How many Instagram followers do you currently have? Question Title * 10. What is your Instagram URL? Question Title * 11. Are you currently active on Instagram? Yes No Question Title * 12. Are you currently an Aflac employee, agent, broker or policyholder? Yes No Question Title * 13. For this campaign, you will be required to publish two Instagram posts. Both posts must go live between February 8-11th. You will be compensated $40 via PayPal for this campaign. Are you willing to complete all tasks stated above? Yes No Question Title * 14. Please tell us why you think you would be a great fit for this campaign and how your post would be unique. Done