Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64MS FOCUS AMBASSADOR APPLICATION Name ________________________________________________________________________________ Address _______________________________________________________________________________ City ___________________________________ State __________________ Zip __________________ Day Phone _____________________________ Alternate Phone _____________________________ Email Address _________________________________________________________________________ Are you comfortable talking about your personal experience with MS? q Yes q No Are you now, or have you been in the past, a spokeperson for a q Yes q No pharmaceutical company or another MS organization? If yes, please indicate for whom you served: _____________________________________________ Do you have a computer and access to the internet? q Yes q No Are you willing to travel to attend MS Focus events and do you have q Yes q No access to transportation to do so? Please attach this form to your application and include the following: q Typed essay (Limit of 1,000 words or less.) q A photo of yourself. Your application must answer the following questions: A) What do you know about MS Focus and its programs and services? B) What qualities or past experiences make you a good candidate for this volunteer position? C) Briefly describe how MS affects your life on a daily basis? D) What is the most important message to get out about MS Focus and how would you do it? Applications will be accepted through the mail and online. Both must be received or time-stamped by April 15, 2017. (See www.msfocus.org for instructions for submitting your application online.) Selectees will be notified by May 15, 2017. Mail to: The Multiple Sclerosis Foundation: Ambassador Program Committee 6520 North Andrews Ave., Fort Lauderdale, FL 33309 Additional applications can be obtained by emailing ambassadors@msfocus.org or calling 888-MSFOCUS (673-6287).