HAC 2026 Social Media Ambassador Interest Form

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* 1. Full Name

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* 2. Email Address

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* 3. Phone Number

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* 4. Organization (if applicable)

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* 5. Title/Role

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* 6. City and State

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* 7. Which platforms do you actively use for professional or advocacy purposes?(Check all that apply)

☐ Twitter/X

☐ Instagram

☐ LinkedIn

☐ Facebook

☐ TikTok

☐ Threads

Other (please specify)

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* 8. Please list your social media handles (public/professional accounts only)

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* 9. Approximately how many followers do you have across your platforms combined?

Under 500

500–1,000

1,000–5,000

5,000–10,000

10,000+

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* 10. Have you attended at least one in-person Health Action Conference?

Yes

No

Other (please specify)

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* 11. Briefly detail why you’re interested in serving as a Social Media Ambassador for #HealthAction2026:

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* 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?

Yes

No

Other (please specify)

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* 13. Are you interested in being featured in HAC promotional content (e.g., short videos, testimonials, or social media highlights)?

Yes

Maybe – tell me more

No, thank you

Other (please specify)