Bally Brook Influencer Request form

CONTACT INFO

Name

First Name

Last Name

Phone

(###)

###

####

Text Friendly

Yes

Website URL

http://

DETAILS OF YOUR REQUEST

WHAT TIME OF YEAR WOULD YOU LIKE TO STAY

MY DATES ARE FLEXIBLE

YES

PRIMARY CHANNEL

Primary Channel

What channel do you have the most influence/largest following?

Primary Website URL:

http://

Total Followers / Subscribers

AUDIENCE

Your Offer

Clearly outline your offer to us in the space below. What channels? Frequency of posting? Is anyone else joining you? Photos, video, etc?

Comment Area

Anything else you'd like to add to your request?

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