Aging2.0 Chapters - Local Chapter Ambassador Application

Aging2.0 Chapter Application

Aging2.0 is a global movement and we're looking for help from talented and motivated people to get involved in building up local communities in their area. Please use this form to share a little bit about yourself and why you're interested to become an Aging2.0 Chapter volunteer / Ambassador
1. About You
Full Name*

First NameLast Name
Title
Organization*
E-mail*
Mailing address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone number (International format)*
+1 for US/Canada numbers, +44 for UK numbers etc
Personal Twitter
Work Twitter
LinkedIn Profile URL:
Organization website
Organization description
Personal website / blog
Summary bio (50 words)*
50 words max
Your skills and expertise (up to 10 comma separated keywords)*
e.g. telehealth, startups, events, marketing
Picture (headshot)

Upload a File

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Resume / bio

Upload a File

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2. Getting involved
What CITY would you like to start / join an Aging2.0 Chapter*
No extra text please - just name the city
What STATE (optional) and COUNTRY would you like to start / join an Aging2.0 Chapter

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Why do you want to get involved with Aging2.0?*
Help us to understand your motivation and interest
How did you first learn about starting a Chapter?
Did an existing Aging2.0 Chapter recommend you start a Chapter? If so, please list that Chapter.
Have you attended an Aging2.0 event/s in the past? Which ones?
Are you already connected with (ex. friends with, have spoken to) a Chapter Ambassador/Core Volunteer in another city? If so, please list name and city.
Additional notes about location
Any additional comments about where you want to get involved
Would you be willing to help organize event/s?
What specific activities would you most like to work on?
How would you like to be involved? *

Leadership role (Ambassador)Planning and / or helping with eventsBeing on a local Advisory BoardHelping find sponsorshipLiaising with aging servicesWriting blogs, reports and social mediaOther

How much experience in using web-based community tools (such as Eventbrite, Wordpress etc)

	1	2	3	4	5

1 is No experience, 5 is Very experienced

3. Partnerships and Collaborations
What organization affiliations will you draw upon for the organization of events and the development of the local Aging2.0 network?
Government (federal, state, local), associations, startups, industry groups, etc.
What are some ideas you have for speakers at future events?
What do you see as the biggest challenge in growing the Aging2.0 community in your area?
Is there any other information that would be helpful for us to review your application?
Values: The values of Aging2.0 are innovation, collaboration and respect for all ages. We expect all people applying for and working with Aging2.0 to uphold these values.

Policies: The minimum age to be an Ambassador is 18 years old. Please read all of the information at aging2.com/local and check the box below if you understand and agree to the policies outlined there.

Subject to change: this program is subject to change. We will communicate with you updates about the program and your participation on a regular basis.
Please confirm your acceptance of our Values and Policies*

Yes, I understand and am committed to the values and policies of Aging2.0
Should be Empty:

Aging2.0 Chapter Application

1. About You

2. Getting involved

3. Partnerships and Collaborations