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Email *
First Name
Last name
Zip/Postal Code
Email Address
Phone number (please include area code)
I am a  . . . . . . of an individual with Cri du Chat Syndrome
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Are you a member of the 5p- Society? If yes, are you in good standing (have you paid your membership dues)?
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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.?
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
Name (Reference #2)
Email address
Phone number
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.
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