Chatting to Wellness Ambassador Interest Form
Please complete this form to express your interest in being an Ambassador for Chatting to Wellness. We will follow up with you shortly as we begin on boarding more people.

As an Ambassador you will be representing the work Chatting to Wellness conducts outside of regular Chatting Sessions with seniors. The Ambassador Program will provide you with a certain task each month to complete within your community, and is a great way to impact the lives of seniors in need.

Also, like our Facebook page to stay in the loop with what we are doing:

If you have any questions contact
Full Name *
Age *
Email *
Phone Number *
Address *
City *
Current School and Year/Grade (If applicable)
Do you agree to receive communications from Chatting to Wellness through email *
[OPTIONAL] Additional Comments (languages, how else you can help, etc.)
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