Survivor Voices Agency: Brand Inquiry Form
Section 1: Contact Information
Name
*
First Name
Last Name
Company/Organization Name:
*
Company Website:
*
Your Role/Title:
*
Work Email:
*
example@example.com
How did you hear about SVA?
*
Section 2: The Opportunity
Which talent niche are you interested in? (Select all that apply)
*
Oncology (Breast, Colon, Hodgkins Lymphoma, Ovarian, Prostate)
Chronic Illness (Diabetes, Heart Disease, Lupus, Sickle Cell Anemia)
General Health & Wellness Advocacy
Sensitivity Consulting (Agency Services)
Other
Nature of Inquiry:
*
Social Media Campaign (IG, TikTok, FB, YouTube)
Speaking Engagement/Keynote
Long-term Ambassadorship
Sensitivity Reading/Consulting
Other
Campaign/Project Goals: (e.g., Awareness, Education, Clinical Trial Recruitment)
*
Section 3: Logistics & Compliance
Is this a Pharmaceutical Campaign?
*
Yes
No
Are there specific Med-Legal or MLR review timelines we should be aware of?
*
Estimated Campaign Launch Date:
*
-
Month
-
Day
Year
Date
Requested Deliverables: (e.g., 1x Reel, 3x Stories, 1x Blog post)
*
Back
Next
Usage Rights Needed:
*
Organic Only
30-90 Days Paid Whitelisting
1 Year+ Full Digital Rights
Section 4: Investment
What is your estimated budget for this partnership?
*
Under $5,000
$5,000 - $15,000
$15,000 - $50,000
$50,000+
Section 5: Final Details
Do you have a pre-existing brief or mood board?
*
Yes
No
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Any specific "Hard No" or restricted language for this brand?
*
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