Become an Ambassador Name First Name * Last Name * Employer Title or Responsibility Business Address Address Line 1 Address Line 2 City State Select option... Alabama Alaska Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming DC Zip/Postal Code Email * Personal Home Address Address Line 1 Address Line 2 City State Select option... Alabama Alaska Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming DC Zip/Postal Code Home Phone Cell Phone Date Format: M/d/yyyy Brief Questionnaire Why did you decide to become a Chamber Ambassador? * What role do you feel the Chamber serves in this community? * How can we stay relevant in the business community? What services/events can we provide to stay viable? * What do you hope to gain from being a Chamber Ambassador? * Community Activities * List key community, civic, professional, business, social and other organizations you are currently involved in. Include organization name and any position held. * I understand the roles and responsibilities of a Chamber Ambassador and can commit the time to fulfilling these responsibilities. * I accept