VOLUNTEER AMBASSADOR APPLICATION

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First Name

Last name

Address

City

State/Province

Zip/Postal Code

Email Address

Phone number (please include area code)

I am a . . . . . . of an individual with Cri du Chat Syndrome

Parent

Grandparent

Sibling

Friend

Teacher

Therapist

Doctor

Other:

Clear selection

Are you a member of the 5p- Society? If yes, are you in good standing (have you paid your membership dues)?

Yes

Not yet, can you send me a form

Other:

Clear selection

Please explain your public speaking experience in a small group setting? Do you have experience with tabling at events such as health fairs, etc.?

Please explain why you are interested in becoming an Ambassador for the 5p- Society.

Please provide two references: Name (Reference #1)

Email address

Phone number

Relationship

Name (Reference #2)

Email address

Phone number

Relationship

How did you hear about the Ambassador program?

Please send your resume or CV to Laura Castillo - director@fivepminus.org

Thank you for your interest. The Ambassador selection committee will review your application and will get in touch with you for an interview.

Submit

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