100th Celebration Ambassador Contact Information FOrm

We are putting together a roster to help Event Cabinet Members, Board Members, and Event Task Force stay connected and easily reach each other as we plan for the 100th celebration event.
Please complete by May 21, 2025

NAME to be on printed materials, e.g. event letterhead

First Name

Last Name

NAME to be on nametag for event - related activities, e.g. nickname

First Name

Last Name

Work Affiliation or, if retired, can write in Community Advocate

Preferred EMAIL address

Best PHONE NUMBER to reach you

(###)

###

####

Landline

Mobile

HOME ADDRESS

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Short bio to share with others (e.g. - work history, connection to HEAR Wisconsin, and or something interesting about yourself)