HAC 2026 Social Media Ambassador Interest Form Question Title * 1. Full Name (Required.) Question Title * 2. Email Address (Required.) Question Title * 3. Phone Number (Required.) Question Title * 4. Organization (if applicable) (Required.) Question Title * 5. Title/Role (Required.) Question Title * 6. City and State (Required.) Question Title * 7. Which platforms do you actively use for professional or advocacy purposes?(Check all that apply) (Required.) ☐ Twitter/X ☐ Instagram ☐ LinkedIn ☐ Facebook ☐ TikTok ☐ Threads Other (please specify) Question Title * 8. Please list your social media handles (public/professional accounts only) (Required.) Question Title * 9. Approximately how many followers do you have across your platforms combined? (Required.) Under 500 500–1,000 1,000–5,000 5,000–10,000 10,000+ Question Title * 10. Have you attended at least one in-person Health Action Conference? (Required.) Yes No Other (please specify) Question Title * 11. Briefly detail why you’re interested in serving as a Social Media Ambassador for #HealthAction2026: (Required.) Question Title * 12. Are you willing to post on your social media platforms at least 2–3 times per month about the conference from now until January 2026? (Required.) Yes No Other (please specify) Question Title * 13. Are you interested in being featured in HAC promotional content (e.g., short videos, testimonials, or social media highlights)? (Required.) Yes Maybe – tell me more No, thank you Other (please specify) Done