Joing FFC Program - PAUSE4Life

PAUSE4Life Program
Contributor Application

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Personal Information

Name

First

Last

Date of Birth

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Please upload a clear image of the front and back of your government-issued ID (e.g., driver's license).

Front of ID

Click or drag a file to this area to upload.

Note: This information is required for identity verification purposes and will be handled with strict confidentiality in accordance with privacy laws.

Please provide links to your social media profiles where you will be promoting the program

Instagram Handle

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Facebook Profile

YouTube Channel

TikTok Handle

Other Platforms

Briefly describe why you are interested in participating in the PAUSE program

Have you or someone close to you been affected by fentanyl poisoning?

Yes
No
Prefer not to say

Would you be interested in collaborating with other influencers for this program?

Please provide your online payment handle for Venmo or other platforms

Terms and Conditions

I have read, understood, and agree to the Terms and Conditions for participating in the FFCF PAUSE program.

PAUSE4Life ProgramContributor Application

Personal Information

© January 14, 2025 | FFCF 501c3

PAUSE4Life Program
Contributor Application