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PFF Ambassador Request Form
Thank you for your interest in requesting a
Pulmonary Fibrosis Foundation (PFF) Ambassador
for your event.
PFF Ambassadors undergo formal training to prepare for speaking and advocating on behalf of the PFF and the pulmonary fibrosis (PF) and interstitial lung disease (ILD) community. Ambassadors share their personal experiences while promoting disease awareness, education, hope, and inspiration for those affected by PF and ILD.
PFF Ambassadors are available to speak at PFF Care Center Network events, support group meetings, fundraising events, educational programs, and other disease awareness activities.
Please complete the information below to help us process your request
.
If you have any questions about requesting a PFF Ambassador, please contact the
PFF Help Center
at
844.TalkPFF
(844.825.5733) or email
help@pulmonaryfibrosis.org
.
*
1.
Contact information
(Required.)
Name
*
Email address
*
Phone number
*
2.
Is this event in-person or virtual?
(Required.)
In-person
Virtual
3.
For in-person events: If the Ambassador is unable to attend in-person, would you accept a virtual presentation?
Yes
No
N/A
*
4.
Event information
(Required.)
Event title
*
Event date
*
Event time
*
Address of event
Address 2
City/town of event
*
State of event
*
Zip code of event
*
5.
Type of event
(Required.)
PFF Care Center Network event
Support group meeting
Fundraising event
Educational program
Stakeholder perspective for research proposal or study
Other disease awareness activities
Other (please specify)
*
6.
How many PFF Ambassadors would you like to participate in this event?
(Required.)
*
7.
The PFF Ambassador Program includes speakers who are patients, caregivers, lung transplant recipients, and those who have lost a loved one to serve as spokespeople for PF and ILD. Please indicate the type(s) of Ambassador you would like to request for your event. Select all that apply.
(Required.)
Patient
Caregiver
Lung transplant recipient
Lost a loved one to PF or ILD
*
8.
Please provide a brief description of the event and any other information that you think will be helpful.
(Required.)
*
9.
Who is the primary audience for this event?
(Required.)
Patients
Caregivers
Healthcare professionals
Family and friends
General public
Other (please specify)
*
10.
Approximately how long will the Ambassador have to speak? Please indicate if they need to leave part of this time to answer questions or if there will be extra time allotted to answer questions.
(Required.)
*
11.
Are there any specific topics you would like the Ambassador to discuss? (e.g., clinical trials, caregiving, supplemental oxygen use)
(Required.)
