CHC Mission Ambassador and Honoree Form
Hello, and welcome to the Ride of a Lifetime! 
Whether you are new or returning, we're so thankful that you or your child are joining us as a Mission Ambassador for the Arthritis Foundation's Carolina Hills Classic Bike Tour. 

Thanks to you sharing your story, CHC participants and volunteers make a deeper connection to the Arthritis Foundation's mission. Many of them tell us that hearing our honorees speak are their most meaningful moments of CHC. We appreciate you telling us about your personal journey with arthritis and how the Foundation has assisted you and we're very grateful for your help!

Completing the questionnaire below and uploading photos to Dropbox will take approx. 10-15 minutes. 
Note, this form (the questionnaire) has to be completed in one sitting; it's not possible to save your work and come back to it. 

Please contact Erin Starck at estarck@arthritis.org if you have any questions.
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Email *
Name of Mission Ambassador *
First and last
Mission Ambassador's preferred pronouns? *
Contact Person
If Mission Ambassador is under age 18, please provide parent/guardian's first and last name. Otherwise, please type "Self"
Phone Number of Ambassador (or Contact Person) *
Age of Ambassador (if under 18)
City and State of Residence *
Please tell us about the ambassador's journey with arthritis. *
Please share as much detail about your symptoms, diagnosis, treatment, and prognosis as you feel comfortable. How old were you when you first experienced symptoms and became diagnosed? What are your treatments like? How does arthritis affect you? The information shared here WILL be published in CCC materials and potentially with media outlets and publications.
How has the Arthritis Foundation helped the ambassador? Please be specific. *
What, if any, experience has the ambassador had with CHC in the past? *
What are the ambassador's words of encouragement the Carolina Hills Classic Bike Tour participants? *
Is there anything else the ambassador would like us to know? *
I hereby grant the Arthritis Foundation, and its representatives, employees and agents permission to publish the information self-disclosed.

IN WITNESS WHEREOF, the undersigned, intending to be legally bound hereby sets their hand and seal the date  by clicking the box.
 *
Required
Using this Dropbox link, please provide us with 1-3 head-and-shoulder photos that are high resolution (at least 1MB) and clearly show the mission ambassador's face.

Please include the ambassador's first and last name in the images that are uploaded.  Selected images, as shown here, will be used on Honoree Posters, as well as Daily Route Guides, Flyers, and in our daily newsletters during the tour and throughout the year.
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