HEARTSafe Ambassador Interest Form

Ambassador Interest Form
Thank you for your interest in becoming a HEARTSafeHB Ambassador! Please fill out the form below. Once completed, please download the Slack app onto your phone and we will add you to the HEARTSafeHB channel so you can stay up to date on upcoming training opportunities and meetings.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
How did you learn about our HEARTSafeHB Ambassador Program?*
Select all that apply:

I am a high school studentI am a college studentI am a CERT memberI am a City Jr. GuardI am a member of a service clubI am in the EMS or medical fieldOther
What population or group do you hope to approach with CPR Training? *
Why are you interested in becoming a HEARTSafeHB Ambassador?*
Should be Empty: