Begin Your "You Block" submission here

Congrats! YOU are about to be a part of an awesome social movement that will help humanity through the power of good conversation.

Contact Information

This Form Is For A "You Block" Recipient

Please select Your "You Block"  ID (5 digit pin on back of "You Block")

Your Name

Age

What date did you receive a "You Block"?

What city/state did you receive a "You Block"?

How did you get a "You Block"?

Where do you plan to give your "You Block" away?

Important

Thanks for sharing your info with us! These next few questions are super important. They are the purpose of this social movment.

What is your favorite memory?

What do you want to be remembered by?

What frustrates you the most?

What's going on in your life right now?

How does someone add color to this world?

Photo Submission

Tips for a good photo:

  • Make sure we see your face
  • make sure we see the "You Block" in your photo

Please note the following

  • you should never submit a nude or in lingerie

Thank You

You have completed the "You Block" submission form. Make sure and check the box stating you have read and accepted the application process and rules as well as the privacy policy

  • fil in your email so we can confirm your submission.
  • click the submit button once you are done filling out your "You Block" submission form.
  • submission has been accepted when you have clicked the submit button and notification is sent to your provided email address

terms
Put terms here.