ICY PR INTAKE FORM

MAIN DETAILS

Your First Name
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Your Best Email Address
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Your Last Name
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What would you like to be known as: E.g Life Coach
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Your Best Phone Number
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Your Address
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Zipcode
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City
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  • - select your country -
  • Åland Islands
  • Afghanistan
  • Albania
  • Algeria
  • American Samoa (US)
  • Andorra
  • Angola
  • Antigua and Barbuda
  • Argentina
  • Armenia
  • Australia
  • Austria
  • Azerbaijan
  • Bahamas
  • Bahrain
  • Bangladesh
  • Barbados
  • Belarus
  • Belgium
  • Belize
  • Benin
  • Bermuda (UK)
  • Bhutan
  • Bolivia
  • Bosnia and Herzegovina
  • Botswana
  • Brazil
  • Brunei
  • Bulgaria
  • Burkina Faso
  • Burma (Myanmar)
  • Burundi
  • Cambodia
  • Cameroon
  • Canada
  • Cape Verde
  • Central African Republic
  • Chad
  • Chile
  • China
  • Colombia
  • Comoros
  • Congo, Democratic Republic of the
  • Congo, Republic of the
  • Cook Islands (NZ)
  • Costa Rica
  • Croatia
  • Cuba
  • Cyprus
  • Czech Republic
  • Denmark
  • Djibouti
  • Dominica
  • Dominican Republic
  • East Timor (Timor-Leste)
  • Ecuador
  • Egypt
  • El Salvador
  • Equatorial Guinea
  • Eritrea
  • Estonia
  • Ethiopia
  • Falkland Islands (UK)
  • Faroe Islands (Denmark)
  • Fiji
  • Finland
  • France
  • French Guiana
  • French Polynesia (France)
  • Gabon
  • Gambia
  • Georgia
  • Germany
  • Ghana
  • Gibraltar (UK)
  • Greece
  • Greenland (Denmark)
  • Grenada
  • Guam (US)
  • Guatemala
  • Guernsey (UK)
  • Guinea
  • Guinea-Bissau
  • Guyana
  • Haiti
  • Honduras
  • Hong Kong (China)
  • Hungary
  • Iceland
  • India
  • Indonesia
  • Iran
  • Iraq
  • Ireland
  • Isle of Man (UK)
  • Israel
  • Italy
  • Ivory Coast
  • Jamaica
  • Japan
  • Jersey (UK)
  • Jordan
  • Kazakhstan
  • Kenya
  • Kiribati
  • Korea, North
  • Korea, South
  • Kosovo
  • Kuwait
  • Kyrgyzstan
  • Laos
  • Latvia
  • Lebanon
  • Lesotho
  • Liberia
  • Libya
  • Liechtenstein
  • Lithuania
  • Luxembourg
  • Macau (China)
  • Macedonia
  • Madagascar
  • Malawi
  • Malaysia
  • Maldives
  • Mali
  • Malta
  • Marshall Islands
  • Mauritania
  • Mauritius
  • Mayotte (France)
  • Mexico
  • Micronesia, Federated States of
  • Moldova
  • Monaco
  • Mongolia
  • Montenegro
  • Morocco
  • Mozambique
  • Namibia
  • Nauru
  • Nepal
  • Netherlands
  • New Caledonia (France)
  • New Zealand
  • Nicaragua
  • Niger
  • Nigeria
  • Niue (NZ)
  • Norfolk Island (Australia)
  • Northern Mariana Islands (US)
  • Norway
  • Oman
  • Pakistan
  • Palau
  • Palestinian territories
  • Panama
  • Papua New Guinea
  • Paraguay
  • Peru
  • Philippines
  • Pitcairn Islands (UK)
  • Poland
  • Portugal
  • Qatar
  • Réunion (France)
  • Romania
  • Russian Federation
  • Rwanda
  • São Tomé and Príncipe
  • Saint Helena, Ascension and Tristan da Cunha (UK)
  • Saint Kitts and Nevis
  • Saint Lucia
  • Saint Pierre and Miquelon (France)
  • Saint Vincent and the Grenadines
  • Samoa
  • San Marino
  • Saudi Arabia
  • Senegal
  • Serbia
  • Seychelles
  • Sierra Leone
  • Singapore
  • Slovakia
  • Slovenia
  • Solomon Islands
  • Somalia
  • South Africa
  • South Sudan
  • Spain
  • Sri Lanka
  • Sudan
  • Suriname
  • Svalbard and Jan Mayen (Norway)
  • Swaziland
  • Sweden
  • Switzerland
  • Syria
  • Taiwan
  • Tajikistan
  • Tanzania
  • Thailand
  • Togo
  • Tokelau (NZ)
  • Tonga
  • Trinidad and Tobago
  • Tunisia
  • Turkey
  • Turkmenistan
  • Tuvalu
  • Uganda
  • Ukraine
  • United Arab Emirates
  • United Kingdom
  • United States
  • Uruguay
  • Uzbekistan
  • Vanuatu
  • Vatican City
  • Venezuela
  • Vietnam
  • Wallis and Futuna (France)
  • Western Sahara
  • Yemen
  • Zambia
  • Zimbabwe
- select your country -
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Did you attend university? what did you get your degree in? do you have any advanced degrees or qualifications?
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What skills or hobbies are you really great at that you enjoy? E.g swimming, knitting, juggling, scubadiving, golfing, running, professional dancing etc.
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What is something interesting about you that people would never know? E.g. You Touched a tiger, you once did 3 miles in 3 minutes.
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Describe your ideal client:
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What does your product or service do for them?
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What problem do you solve for your clients?
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What is the unique story behind your brand and why you do what you do?
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What is the key message you want to convey to your clients?
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Share 5 emotions or words that best describes how you want your clients to feel from working or experiencing you.
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SOCIAL MEDIA DATA

How many instagram followers do you have?
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Share vital linkedin numbers that work in your favor
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What is your website page view per week?
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What is the median income of your ideal clients? E.g $125k-$150K, $100K-$125K , $75k-$100K etc.
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What are your top 3 engagement days on social media?
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How many twitter followers do you have?
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How many impressions do you get per week on instagram?
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What is your website page view per month?
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Do you have an email list/newsletter if so, how many people in total are on your list?
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Which social media platform has your most engaged audience?
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How many Youtube subscribers do you have?
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How many views on average do you get per live-stream or insta-story you do?
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What are the top 5 cities you get the most engagement from?
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Do you know the average open rate and click rate of your newsletter? please share
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Which is your most preferred mode of interaction: video, audio or blogs
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list the various % and demographic of your social media audience. E.g.97% are women 3% are men, 27% are women 25-34 41% are women 35-44 21% are women 45-54
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How many followers do you have on Instagram?
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SOCIAL MEDIA DETAILS

What is Your Instagram Username? @
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What is Your Instagram Url?
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What is Your Facebook Username?
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What is Your twitter Username?
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What is Your Youtube Username?
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What is Your LinkedIn Username?
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What is Your Facebook Url?
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What is Your Twitter Url?
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What is Your Youtube url?
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What is Your Linkedin url?
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LOGO QUESTIONS

What is the name or letter you want to appear in you logo?
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Do you want all those words in the logo?
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List the services or products you provide to your ideal clients
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When you think of complimenting brand elements, do you imagine circles, lines, flowers, unique shapes?
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Provide 3 words that describe how people should feel about you, your company, service or product.
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What are your own 2 favorite colors? (write out the colors here, and use the color picker to identify the right shade)
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Based on your brand session, what colors represent your top 3 emotion words (write out the colors here, and use the color picker to identify the right shade)
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Do you have a slogan? What is it?
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What kind of font do you imagine for your logo?
  • - select an option in the dropdown-
  • Script
  • Bold
  • light
  • art illustration
  • combination
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What animal do you believe symbolizes your brand?
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Target_audience
Who is your target audience?
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What kind of items will your logo be used on?
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Sample Logos
Are there sample logos that have elements you would like in your logo? Please upload your top 3
Upload sample logo 1
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Upload sample logo 2
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Upload sample logo 3
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Top 3 competitiors
Who are your top 3 competitors?
What is their name?
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http://
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What is their name?
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http://
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What is their name?
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http://
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What impression do you want the viewers to have after seeing your logo?
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Biography
Please share your professional biography below
I am ...
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Social Media Likes
List 3 people or companies whose social media you like?
Name and url
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Name and url
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Name and url
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MEDIA KIT PACKAGE

Speaker Profile
Please list below events you have been a speaker for (name of event, topic, month and year), on a panel or moderated over the last 5 years.
I have spoken at
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List 5 topics you can confidently speak about. E.g: The secret sauce to turning your clients into fanatical, raving fans
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If you had a signature talk, what would you call it?
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If you had a 30-45 minutes workshop, what would you call it?
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Talk fees
How much would you charge for your signature talk?
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Workshop fees
How much would you charge for your workshop?
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Awards
List if any, awards you have won or received in the past 7 years.
Awards
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Testimonials
Share 3-5 testimonials from people or organization who have experienced you speak. Include the persons name, title and picture if you have it
Testimonial 1
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Picture of person 1 or company logo
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Testimonial 2
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Picture of person 2 or company logo
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Testimonial 3
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Picture of person 3 or company logo
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Testimonial 4
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Picture of person 4 or company logo
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Testimonial 5
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Picture of person 5 or company logo
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Please list any and all media outlets you have been featured in (radio, TV, magazine, blogs, podcast etc)
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Is there any other information you would like to share that will help make a great story for your brand launch or help brands be more excited about working with you
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