EmPOWERED To Serve Ambassador Registration
First Name (required)
*
Last Name (required)
*
Email (required)
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Zip code
Organization/Chapter (if applicable)
What is your expertise/profession/skill set? (check all applicable)
Physician
Nurse
Other medical professional
Researcher
Fitness expert
Chef
Videographer
Photographer
Speaker
Social Media expert
Social Entrepreneur
Other
Physician area of focus
What areas of specific areas are you most interested in?
Food access
Affordable Housing
Education
Employment
Access to healthcare
Transportation
Public safety
City planning and infrastructure
CPR Training
High Blood Pressure
Stroke
Tobacco Free Environments
Other
As an EmPOWERED To Serve Ambassador I would like:
Receive the monthly electronic newsletter
Provide/develop content (for programs, social media, website, etc.)
Amplify important messaging and programming for EmPOWERED to Serve and the AHA
Speak at a conference
Serve on a national or local board
Become part of the local affiliate activations and opportunities
Be a part of You’re the Cure Network (advocate for local policies and issues)
Volunteer for one of our EmPOWERED to Serve Business Accelerator organizations
Other
Please include any social media handles / URLs you would like us to follow:
Twitter Handle
Facebook
Instagram
SnapChat
My specific areas of interest are:
CPR Training
High Blood Pressure
Healthy Living (physical activity, food choices)
Stroke
Tobacco Free Environments
The social or economic issues that impact health I'm interested are:
Culture and Traditions
Education
Ability to earn income
Neighborhood or Community
Access to Healthcare
Submit
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