PSI-GA Ambassador Application
Thank you for your interest in becoming an Ambassador for the PSI GA chapter and/or volunteering to support the programming and events of PSI GA. We are grateful for the support of all our volunteers and look forward to learning more about you and working with you in the near future.
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Email address
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Your email
Today's date
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Personal Information
Please fill out the following information. This data is for chapter use only and will not be sold or used for outside purposes.
Name:
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Your answer
Mailing Address:
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Your answer
City, State:
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Your answer
Phone:
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Your answer
Professional Website:
Your answer
Occupation:
Birth Worker
Clinician/Therapist
Medical Provider
Public Health Professional
Peer Support/Advocate
Social Worker
Student
Other:
Clear selection
What is your personal or professional experience with perinatal mood and anxiety disorders - PMADs (postpartum depression and anxiety)?
Your answer
What is you preferred level of involvement, at this time?
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Choose
3 yr commitment to programs and events as well as interest in serving on the Board of Directors
1 yr commitment to programs and events as well as serving on a committee
Less than 6 month commitment to programs and/or events
No committment - Interested in increasing awareness of PSI among my network
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