My AFib Experience Community Leader Application Question Title * 1. First and Last Name Question Title * 2. In which city, state, and country do you reside? Question Title * 3. Age Question Title * 4. How have you been impacted by atrial fibrillation? I have atrial fibrillation I care for someone who has atrial fibrillation Question Title * 5. When were you (or your loved one) diagnosed with AFib? Please tell us about this experience. Question Title * 6. Why do you want to be a Community Leader in My AFib Experience? Question Title * 7. What can you contribute in this role as a Community Leader? Question Title * 8. Do you have a passion for supporting others with AFib? Yes No Question Title * 9. Are you willing to commit time to read/respond to postings in the forum at least 3 times per week? Yes No Question Title * 10. Are you willing to write short blog posts for My AFib Experience 1-2 times per month? Yes No Question Title * 11. Are you willing to participate in initial training calls and communicate with AHA/StopAfib.org staff on a regular basis? Yes No Question Title * 12. Are you willing to be featured in a promotional video or other media opportunity if available? Yes No Question Title * 13. Have you read the community guidelines and terms of service and are you willing to comply with them? Yes No Question Title * 14. Are you willing to be respectful to responding to users in the forum? Yes No Question Title * 15. Do you agree to refrain from giving medical advice in the forum as a Community Leader? Yes No Question Title * 16. Do you regularly have access to a computer and internet? Yes No Question Title * 17. Are you able to easily navigate through MyAFibExperience.org and utilize the community forum? Yes No Question Title * 18. Are you proficient in English? Yes No Question Title * 19. Do you smoke or use tobacco products? Yes No Done