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VOLUNTEER AMBASSADOR APPLICATION
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Email
*
Your email
First Name
Your answer
Last name
Your answer
Address
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City
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State/Province
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Zip/Postal Code
Your answer
Email Address
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Phone number (please include area code)
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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
No
Not yet, can you send me a form
Other:
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Please explain your public speaking experience in a small group setting? Do you have experience with tabling at events such as health fairs, etc.?
Your answer
Please explain why you are interested in becoming an Ambassador for the 5p- Society.
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Please provide two references: Name (Reference #1)
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Email address
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Phone number
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Relationship
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Name (Reference #2)
Your answer
Email address
Your answer
Phone number
Your answer
Relationship
Your answer
How did you hear about the Ambassador program?
Your answer
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.
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