JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Recovery & Disruption Plan
If you are a current V2 token holder, please complete this form.
Please note, this form is NOT related to the contest Airdrop. Please fill this out separately.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Email Address
*
Your answer
Current LYF Holdings (Total Amount)
*
Your answer
ETH Wallet Addresses (All That Hold LYF)
*
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Lillian Bay Medical Inc..
Report Abuse
Forms