Your Bitcointalk username : crypto_circuit
Twitter handle : https://twitter.com/kryptoViews
Facebook handle : https://m.facebook.com/crypto.circuit
Steemit : https://steemit.com/@devblock
Ethereum Adddress (must match with the one that you filled in form) : 0x76256bc90f78e7d6ccb43d0a48aae6fe90e6e595