Are You A Wish Ambassador?

If you would like to be considered for the Wish Ambassador program, please fill out the form below. Thank you!
* required information
Wish Ambassador Registration Form 
Contact Information
Wish Child Name:*
Last Name:*
Parent/Guardian First Name:*
Parent/Guardian Last Name:*
Email:*
City:
State:
Phone:
What is the best way to contact you?:
What was the wish?:
How has the wish impacted your family?:
What would you share with others about your wish experience?:
Are you comfortable speaking in front of large groups?: Yes
No
Would you talk to groups outside of your immediate community?: Yes
No
If so, how many miles would you be willing to travel?:
What is your availability?: Weekdays
Weeknights
Weekends
How many times per year would you be willing to speak?: 1-2 times per year
3-4 times per year
5-6 times per year
Monthly
Who in the family would be interested in being an Ambassador?: Wish Child
Mom
Dad
Siblings