Pre-registration Form

1

Name* This field is required.Enter your full name

First Name

Last Name

2

Email* This field is required.Enter a valid email address

3

How Can We Reach You?Select at least 1 social media network where you want to be contacted in the event you are selected as one of the winners of the $5,000 worth of Whitelist. Multiple inputs are possible.

Choose your social media network

Enter handle or username of selected social media network

Choose your social media network

Enter handle or username of selected social media network

Choose your social media network

Enter handle or username of selected social media network

4

MetaMask Wallet Address(Optional Only) Enter a valid MetaMask Wallet Address

Tip: It is best to perform "copy & paste" method when entering wallet addresses to avoid loss of fund

5

Please verify that you are human* This field is required.