Ambassador Program: Ambassador Application

Please fill out the form below to express your interest in becoming a ULF Ambassador!

All applications will be reviewed by the Ambassador Committee, and applicants that are found to be a good match to the program will be contacted to set up an interview with Ambassador Committee Members and/or Current Ambassadors. Questions can be directed to [email protected].

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

How are you connected to the leukodystrophy community? Please select all that apply. *

What type(s) of leukodystrophy are you affected by, or is your primary interest?

Please briefly describe your and/or your family's introduction to the leukodystrophy community? Or how did you become involved in the leukodystrophy community if you aren't personally affected? *

Do you have any special interest areas that may be a valuable contribution to the Ambassador Program? (For example, do you enjoy reading/summarizing medical articles, or do you like to organize fundraising/awareness events?) *

Why are you interested in becoming a ULF Ambassador? *

Please upload your work and volunteer resume/CV here: *

Click or drag files to this area to upload. You can upload up to 10 files.

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