EmPOWERED To Serve Ambassador Registration

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
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
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
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