Request for Ambassador Agent
Welcome to MIB's Ambassador Agents Program. We are a team of experienced families and warriors dedicated to supporting patients, parents, caregivers, extended family and friends of children with osteosarcoma. The goal of this group is to leverage their experiences with this terrible disease to help Make It Better for patients and families dealing with an OS diagnosis. Ambassador Agents offer support and connection to families by experienced and trained families to walk beside them through their osteosarcoma journey; we hope to find someone within your geographic area so meeting in person may be possible. When no one is trained or available in your area we will link you with someone to connect with via phone, video chatting and email.

If you are interested in having a Ambassador Agent contact you, please continue with the below confidential survey so that the Lead Ambassador Agent Coordinators, Liz and Casey (Liz@MIBagents.org and Casey@MIBagents.org), can connect you with the best match based upon your situation and requests. Most information is optional so only fill in what you are comfortable providing.

If you would like further information about either program please contact both Liz and Casey at (Liz@MIBagents.org and Casey@MIBagents.org).

Thank you

Email address *
First name of person filling out this form (as you like to be called) *
Your answer
Last name of person filling out this form.
Your answer
Your relationship with osteosarcoma *
Mailing Address *
Your answer
email *
Your answer
mobile phone number
Your answer
Preferred method of contact *
Required
We know this time is very stressful for you, please help us contact you in the best way for you. Any additional or best methods of contact, please describe.
Your answer
First name of person with osteosarcoma (or self) *
Your answer
Male or female with osteosarcoma
Date of diagnosis (month, year) and location(s) of tumor(s)
Your answer
Age at diagnosis
Your answer
If you are a parent to an osteosarcoma child, what is your marital status
Current status or treatment of person with osteosarcoma
Your answer
First diagnosis type
Current diagnosis (including location(s) of tumor(s), treatments, surgery, issues
Your answer
Name and city of treatment hospital(s)
Your answer
How did you hear about Ambassador Agents and MIB? *
Required
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