PV Ambassador

Personal details

First name

Last name

Email

Phone

Birthday

Month

Day

Year

Multi-line address

Country/Region

Address

City

Zip / Postal code

Condition you are wanting to apply for

How are you impacted by the condition?

Employment status

Upload a picture of yourself. This is for us to get to know you better

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About you and your community

How long have you been living with or caring for someone with this condition?

Are you involved with the rare community, and if so how?

Why do you want to be an ambassador, and what would you bring?

What are your ideas for raising awareness or supporting people with your condition?

Which social media platforms do you use? (select all that apply).

Any relevant experience in communication, writing, media, events or advocacy?

Anything else we should know?

References

Please provide 2 reference letters of support, one of which needs to be an existing RDSA member.

Reference letters

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The legal stuff...

Do you agree with RDSA processing your information in line with our data and privacy policy.

Do you acknowledge the vital role that Patient Ambassadors play in the Rare community and commit to serving the community to the best of your ability?

Do you understand that as a Patient Ambassador, you are subject to the same code of ethics and conduct as the professional staff of RDSA?