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Ambassador Application
Home
Ambassador Application
1
Personal details
2
Ambassador information
3
Synagogue Information and Endorsement
4
Data consent
Name
*
First
Last
Email
*
Phone
*
Address
*
Address Line 1
Address Line 2
Town/City
Post Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
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El Salvador
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Eswatini
Ethiopia
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Nigeria
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Panama
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Venezuela
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Virgin Islands, U.S.
Wallis and Futuna
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Åland Islands
Date of birth
Day
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31
Month
1
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10
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12
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
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1950
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1930
1929
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1927
1926
1925
1924
1923
1922
1921
1920
I am applying to be an ambassador for the following synagogue/community:
*
How did you hear about the Ambassador Scheme?
I have experience in:
Setting personal boundaries
Fundraising
Marketing
Presentation and delivery
Is there any further information you would like us to know, such as relevant life experience?
Please detail your community involvement:
*
On a scale of 1-5, how mental health aware do you consider your community to be?
*
1
2
3
4
5
(1 not at all, 5 extremely)
Is there anything specific you would like to achieve for/bring to your community?
*
The Ambassador application should be endorsed by two members of your community/synagogue (Rabbi/Chairperson/Board). Please provide details of both of your endorsers below.
Who have you been endorsed by?
*
First member endorsement
Email address of endorser
*
First member endorsement
Contact number of endorser
*
First member endorsement
Who have you been endorsed by?
*
Second member endorsement
Email address of endorser
*
Second member endorsement
Contact number of endorser
*
Second member endorsement
By providing this information I confirm that I am consenting to Jami holding and processing my personal data to keep me informed about Jami’s services, courses, events and fundraising. Where you do not grant consent we will not be able to use your personal data; (so for example we may not be able to let you know about forthcoming services and events); except in certain limited situations, such as where required to do so by law or to protect members of the public from serious harm. You can find out more about how we use your data and how to withdraw your consent from our Privacy Notice.
By providing this information I confirm that I am consenting to Jami holding and processing my personal data to keep me informed about Jami’s services, courses, events and fundraising. Where you do not grant consent we will not be able to use your personal data; (so for example we may not be able to let you know about forthcoming services and events); except in certain limited situations, such as where required to do so by law or to protect members of the public from serious harm. You can find out more about how we use your data and how to withdraw your consent from our Privacy Notice.
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