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  • About
    • Board & Staff
    • Head and Neck Cancer Alliance Award
    • 2022 Year-in-Review
    • Corporate & Community Partners
    • Contact Us
  • About Head & Neck Cancer
    • Symptoms
    • Risk Factors
    • Self-Exam Guide
    • Diagnosis & Staging
    • The HPV Connection
      • HPV Resources
    • Treatment & Side Effects
    • Genomics & New Treatments
    • Life After Cancer
    • Lowering Your Risk
    • Brochures
      • Folletos en Español
      • 中文小册子
  • Programs
    • OHANCA
      • Screening Locations
      • Events Calendar
      • OHANCAW Social Media Assets
      • Media Guides
      • Host a Screening
      • Past Spokesperson
    • Move-A-Thon
    • Peer-to-Peer Program
    • Gas Card Program – Open
    • Ambassador
      Program
      • Ambassador Profiles
      • Ambassador Application
      • Request an Ambassador
    • Survivorship Symposium
      • Survivorship Symposium Videos
    • Survivorship Webinars
    • Online Support
      Community
    • Smash Cancer
  • Patient & Caregiver Resources
    • Clinical Trials
      • Clinical Trial Finder
    • Managing Side Effects
      • Dry Mouth
      • Oral Mucositis
      • Lymphedema
      • Neuropathy
      • Osteoradionecrosis
      • Trismus
      • Radiation Fibrosis
      • Nutrition
    • Research Studies
    • Online Support Community
    • Laryngectomee Guide
    • Other Resources
  • Survivorship
    • Survivorship Symposium
      • Survivorship Symposium Videos
    • Survivorship Education Videos
    • Peer-to-Peer Program
    • AHNS – Patient Education on Post-Treatment Care
  • News & Views
    • HNCA Blog
    • Videos
    • Podcasts & Articles
    • e-Newsletter Archives
  • Ways to Donate
    • Donate Electronically
    • Donate By Mail
    • Monthly Giving
    • Matching Gifts
    • Donate Your Car
    • Planned Giving/Stocks
    • Partnerships
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Ambassador Application

Ambassador Candidate Form

Being a speaker is a voluntary role. All new speakers work with the HNCA Communications Director to optimize presentation skills and organize their thoughts. Once approved as a speaker, you will be contacted to share your journey at community events, with researchers and/or fundraising functions.

  • Drop files here or
    Max. file size: 100 MB.
      A headshot of yourself and other photos/images that convey your personal cancer journey.
    • Max. file size: 100 MB.
      6-10 paragraphs of your personal journey (details of family life, age of diagnosis, type of cancer, treatment, years as a cancer survivor and other pertinent details of your cancer journey. Please attach your journey in a word doc. or pdf format.
      I hereby acknowledge that this position is a voluntary role and have no expectation to receive any monetary compensation or reimbursement. I hereby agree to give my consent to share my personal cancer story, along with images/videos submitted, as a speaker for public events, media and/or materials in relation to the Head and Neck Cancer Alliance.
    The information published on this website and in our materials is intended to educate you about Oral, Head and Neck Cancer. The content is not intended to take the place of a discussion with a qualified physician who is familiar with your medical situation. It is important to remember that each individual is different, and the reasons for—and outcomes of—any treatment plan depends on the patient's individual condition. If you have questions or concerns after reading any information on this website or in our materials, you should discuss them openly and honestly with your physician. Any products and manufacturers included on this site are presented for informational purposes only and do not constitute product approval or endorsement by HNCA. The content provided by HNCA is in no way intended to be a substitute for medical consultation with a qualified professional. HNCA encourages those using its resources to be careful when evaluating medical information or products. If you are unsure about your medical condition, consult a physician.

    HNCA Administrative Office:

    1-866-792-4622 (HNCA)

    Head and Neck Cancer Alliance PO Box 21688
    Charleston, SC 29413

    info@headandneck.org

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