EmailMe Form - Spooktacular Swap

Name *
First Last
Blog *
Email *
Twitter Handle
Tell us a little bit about yourself:
Please list any allergies you may have:
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
By checking this box you promise to send your assigned partner an awesome box by the set date. You must also guarantee that you will not back out on your partner. *
I agree.
IF something comes up and you are unable to participate, contact one of the hosts IMMEDIATELY so we can assign your partner someone new. Failure to comply with these rules will land you on a swap blacklist.