EmailMe Form - Mijem Influencer Program

Step 1: Basic Information
Name *
First Last
Phone *
### - ### - ####
Email *
Street Address 1 *
Street Address 2
City *
State/Province *
Zip/Postal Code *
Step 2: Social Network
Your Mijem username *
Your Instagram username *
Your YouTube URL (optional)
Please select at least two below before you apply: *
I have posted a profile picture on Mijem
I have listed 3 things to sell on Mijem
I have followed 3 people on Mijem
I have verified my school email on Mijem
I have followed @mijeminc on instagram
What will you contribute to the influencer program? What posts can we expect you to share? Is there anything else we should know about you?
How did you hear about the influencer program?
Mijem
Friend
Other