ICY PR PERSONAL BRAND INTAKE FORM

MAIN DETAILS

Your First Name
Field is required!
Field is required!
Your Best Email Address
Field is required!
Field is required!
Your Last Name
Field is required!
Field is required!
What would you like to be known as: E.g Life Coach
Field is required!
Field is required!
Your Best Phone Number
Field is required!
Field is required!
Your Address
Field is required!
Field is required!
Zipcode
Field is required!
Field is required!
City
Field is required!
Field is required!
  • - 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 -
Field is required!
Field is required!
Did you attend university? what did you get your degree in? do you have any advanced degrees or qualifications?
Field is required!
Field is required!
What skills or hobbies are you really great at that you enjoy? E.g swimming, knitting, juggling, scubadiving, golfing, running, professional dancing etc.
Field is required!
Field is required!
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.
Field is required!
Field is required!
Describe your ideal client:
Field is required!
Field is required!
What does your product or service do for them?
Field is required!
Field is required!
What problem do you solve for your clients?
Field is required!
Field is required!
What is the unique story behind your brand and why you do what you do?
Field is required!
Field is required!
What is the key message you want to convey to your clients?
Field is required!
Field is required!
Share 5 emotions or words that best describes how you want your clients to feel from working or experiencing you.
Field is required!
Field is required!

SOCIAL MEDIA DATA

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

SOCIAL MEDIA DETAILS

What is Your Instagram Username? @
Field is required!
Field is required!
What is Your Instagram Url?
Field is required!
Field is required!
What is Your Facebook Username?
Field is required!
Field is required!
What is Your twitter Username?
Field is required!
Field is required!
What is Your Youtube Username?
Field is required!
Field is required!
What is Your LinkedIn Username?
Field is required!
Field is required!
What is Your Facebook Url?
Field is required!
Field is required!
What is Your Twitter Url?
Field is required!
Field is required!
What is Your Youtube url?
Field is required!
Field is required!
What is Your Linkedin url?
Field is required!
Field is required!

LOGO QUESTIONS

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

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.
Field is required!
Field is required!
I have spoken at
Field is required!
Field is required!
List 5 topics you can confidently speak about. E.g: The secret sauce to turning your clients into fanatical, raving fans
Field is required!
Field is required!
If you had a signature talk, what would you call it?
Field is required!
Field is required!
If you had a 30-45 minutes workshop, what would you call it?
Field is required!
Field is required!
Talk fees
How much would you charge for your signature talk?
Field is required!
Field is required!
Field is required!
Field is required!
Workshop fees
How much would you charge for your workshop?
Field is required!
Field is required!
Field is required!
Field is required!
Awards
List if any, awards you have won or received in the past 7 years.
Field is required!
Field is required!
Awards
Field is required!
Field is required!
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
Field is required!
Field is required!
Testimonial 1
Field is required!
Field is required!
Picture of person 1 or company logo
Field is required!
Field is required!
Testimonial 2
Field is required!
Field is required!
Picture of person 2 or company logo
Field is required!
Field is required!
Testimonial 3
Field is required!
Field is required!
Picture of person 3 or company logo
Field is required!
Field is required!
Testimonial 4
Field is required!
Field is required!
Picture of person 4 or company logo
Field is required!
Field is required!
Testimonial 5
Field is required!
Field is required!
Picture of person 5 or company logo
Field is required!
Field is required!
Please list any and all media outlets you have been featured in (radio, TV, magazine, blogs, podcast etc)
Field is required!
Field is required!
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
Field is required!
Field is required!
Submit

Copyright © 2019 ALL RIGHTS RESERVED ICYP PR LLC.