AMPLIFY AFRICA | Media, Partnerships, Agency & Events Request Form
Thank you for your interest in working with Amplify Africa. This form is for paid media placements, brand partnerships, talent booking, event collaborations, production services, and agency requests. Please complete all applicable sections. Our team will review and respond within 3–5 business days.
Full Name
*
First Name
Last Name
Company / Brand Name
*
Company Employee Size
*
Less than 10 employees
> 10 employees
Job Title / Role
*
Email Address
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number (with country code)
*
Website / Social Media Links
*
What Are You Interested In?
*
Digital Media & Marketing (interviews, social media features, campaigns)
Brand Partnerships & Sponsorships
Agency Services (creative, production, digital campaigns)
Experiences & Events (hosting, co-production, activation requests)
Other
Please specify if Other is selected
Please describe your request or project in detail (Include goals, target audience, key dates, and expected outcomes)
*
Is this tied to a specific event, launch, or campaign date?
*
Yes
No
Enter date or timeline
Geographic Target Market(s)
*
Please Select
United States
Latin America
Africa (Select Specific Countries)
Europe
Global
Other
What is your approximate budget range?
*
Please Select
Under $1,000
$1,000 – $5,000
$5,000 – $10,000
$10,000 – $25,000
$25,000 – $50,000
$50,000 – $100,000
$100,000+
Are you open to customized packages?
*
Yes
No
How soon are you looking to launch/commence?
*
Immediately (within 30 days)
1–3 months
3–6 months
Flexible / Exploring options
Upload brief, deck, assets, or supporting documents
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Additional Notes
Please confirm:
*
I understand this is a request for paid services and that Amplify Africa will provide pricing and partnership options based on the information submitted.
Terms and Conditions Agreement
*
Signature Field (E-signature)
Submit Request for Review
Should be Empty: