Fight 4 Cure Ambassador Application
Please fill out this form if you're interested in becoming a Fight 4 Cure Ambassador. If chosen, you will be contacted by a board member.
Applicant Name
*
First and Last
Birth Date
*
-
Month
Year
How did you hear about Fight 4 Cure Inc?
Twitter
Instagram
Facebook
Word of Mouth
Other
E-mail
*
Address
*
Street Address
Street Address Line 2
City
Postal / Zip Code
Upload a photo
*
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Instagram Handle
Twitter Handle
Facebook Handle
Any other Misc. Handles
Please tell us about yourself and how you can best represent Fight 4 Cure Inc.
*
Are you currently an Ambassador for any other organization?
*
Yes
No
If you answered yes to being an Ambassador for another organization, please list the name of the organization.
Please verify that you are human
*
Submit
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