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Become A MJF Ambassador
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I am signing up to be an Ambassador as:
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Myself - I am an HIE hero
A Parent - I have a child diagnosed with HIE
A Sibling - My brother or sister has HIE
A Friend - I know someone with HIE
Other - I am a grandparent, cousin, in-law, or other extended family member for someone with HIE
Your Information
First Name
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Your answer
Last Name
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Your answer
Email Address
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Your answer
Phone Number
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Your answer
Address
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Your answer
Address 2
Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Hero Information
Hero First Name
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Your answer
Hero Last Name
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Your answer
Is this hero 18 years or older?
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Yes
No
Hero Birth Date
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Your answer
Gender
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Male
Female
Involvement Interests
Public Appearances - I would like to represent the Macie Jo Foundation (MJF) by:
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Volunteering to host a Miles for MJF event, getting involved during HIE Awareness Month, and supporting MJF events that bring hope and awareness to families affected by HIE.
Speaking at MJF events about how HIE has impacted our family, and thanking participants for supporting the MJF cause.
Speaking to students and staff at schools.
Speaking to media/being interviewed by media
I do not wish to speak in public
If you signed up for Public Appearances, how far would you be willing to travel from your home to speak? Please be specific in listing all cities nearby that you would be willing to represent MJF.
Your answer
Size of group you're comfortable speaking to:
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25 or less
25 - 50
50 - 100
Any size
Not applicable
Age groups you're comfortable speaking to:
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Elementary students
Middle school students
High school students
Adults
Not applicable
Have you been an Ambassador for MJF in the past?
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Yes
No
Are you affiliated with any groups, clubs, organizations, colleges, or universities? If yes, please explain.
Your answer
Please feel free to share any additional details about yourself or interest in involvement.
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How did you learn about the Macie Jo Foundation?
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