Make A Difference (Part 1, Request)
(Please Be Honest In Filling Out The Form)
By Filling Out This Form You Promise To Use This Reward To Make A Difference In Someone's Life
Name
*
First Name
Last Name
Email
*
example@example.com
What is YOUR Membership ID Number
*
How would you like to receive your reward?
*
Please Select
Paypal
Venmo
Coinbase
Gcash
Enter Your Valid and Verified Gcash Number
*
Paypal Email
*
Venmo Username or Email
*
Coinbase Email
*
Tell us who you are going to use the money on to make a difference in their life and why?
*
If you have received a Make A Difference reward in the past what did you do with that reward?
*
Please upload a selfie (Smiling is best)
*
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By Providing Information, You Agree To Allow The Foundation To Use Your Name and Likeness On Leaderboards, Internet and Social Media
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