California Legislative Ambassador Program

Transcription

1 American Cancer Society Cancer Action Network, Inc. California Legislative Ambassador Program 2012 Overview & Application Submit completed applications or questions to: American Cancer Society Cancer Action Network, Inc. California Office 980 9th Street, Suite 2200 Sacramento, CA tel / fax

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3 GET INVOLVED IN THE LEGISLATIVE FIGHT AGAINST CANCER Become A California Volunteer Legislative Ambassador! The American Cancer Society Cancer Action Network (ACS CAN) is a legislative advocacy force that gets results. However, we need the support of every federal, state and local elected official to help eradicate cancer. Your voice and leadership can influence your elected officials when you send s, letters, faxes, make phone calls and personal visits. You can also encourage others to get involved with you to help strengthen our grassroots movement. Legislative advocacy is a force multiplier. In 2006, more than 10,000 ACS CAN Volunteer Legislative Ambassadors and supporters came together in Washington, D.C. to demonstrate to our country s leaders their power, passion and intense desire to end cancer. Because of their effort, truly amazing accomplishments were achieved; including over 340 members of Congress signed the Congressional Cancer Promise in making cancer a national priority. Many if not all of us have been touched by cancer directly or indirectly. There are 1.3 million new cancer cases and more than 550,000 cancer deaths each year over one death per minute. You can make a difference! Your involvement as a California Volunteer Legislative Ambassador can and will help prevent cancer-related death, avert new cancer diagnosis and dramatically improve the quality of life for people living with cancer and their families. Become a California Volunteer Legislative Ambassador, and with us, demand that your elected officials support: o Increased funding for cancer research and prevention o Increased tobacco regulation and taxation o Patient Navigator programs for underserved communities o Cancer-fighting programs for women, men, and children o And many more life-saving decisions that help advance the American Cancer Society Cancer Action Network s mission. Your involvement could make a big difference in the life of someone you love, as well as in the lives of countless others you don t know. Get involved in the legislative fight against cancer become an American Cancer Society Cancer Action Network California Volunteer Legislative Ambassador today! And together, we will put an end to cancer! For more information, contact California State Lead Ambassador, Linda Shaner (lshaner1946@gmail.com) or Ann Goure, Director of Grassroots Advocacy at or You can do this even if you have no prior legislative experience!

4 VOLUNTEER LEGISLATIVE AMBASSADOR DESCRIPTION A California Volunteer Legislative Ambassador is an American Cancer Society Cancer Action Network volunteer that works with, and provides support to, legislative advocacy staff and leadership as well as providing support for local, state and federal advocacy activities in California. California Volunteer Legislative Ambassadors play an integral part in helping with our legislative efforts and are the backbone to the nations most well-respected and trusted health policy organization. RESPONSIBILITIES OF A CALIFORNIA AMBASSADOR Respond to and share ACS CAN Legislative Action Alerts Visit the ACS CAN website ( regularly and become familiar with ACS CAN Visit the California Volunteer Legislative Ambassador webpage regularly and respond to California Volunteer Legislative Ambassador Surveys online Consider joining or renewing your membership in ACS CAN annually Recruit new California Volunteer Legislative Ambassadors and ACS CAN members Participate in Ambassador trainings and conference calls Attend at least three events per year Participate in priority campaigns at Federal, State, and Local levels as needed Be able to knowledgeably represent the Legislative Ambassador Program in public settings Make a personal visit with your local district legislative office annually Send a letter of introduction to your elected officials when you become an Ambassador Send letters-to-the-editor to local media with appropriate messaging TERM & TIME COMMITMENT Approved California Volunteer Legislative Ambassadors will play an important role of their ACT! (Ambassador Constituent Team!). To remain in the Legislative Ambassador Program, volunteer-required responsibilities must be adhered.

5 2012 CALIFORNIA LEGISLATIVE AMBASSADOR APPLICATION Personal Information (please print): First & Last Name: Employer: Job Title: Home/Physical Address: City: State: CA Zip: Day Phone: ( ) Evening Phone: ( ) Preferred Phone: ( ) Cell Phone: ( ) address: Fax: ( ) An address is required to receive the most current communications and action alerts as the material is usually time sensitive. You may find your federal and state representatives at by entering your home/physical address in the search box. Your US Congressional Senators are: Name of your US Congressional House Representative: Name of your California State Senator: Name of your California State Assemblymember: I am under 18 years of age I give permission for my child to apply to become a California Legislative Ambassador. Parent signature: The following is voluntary and used for statistical purposes only. Check all that apply to you: African American Asian/Pacific Islander White Hispanic Native American LGBT Other Cancer-related Experience: Survivor (Cancer type: ) Caregiver Health professional/researcher Family/Friend touched by cancer Volunteer Experience: Length of association with the American Cancer Society and/or American Cancer Society Cancer Action Network: Which of these activities have you been involved in (if applicable)? Making Strides Against Breast Cancer Relay For Life Fundraising (Daffodil Days, Galas/Balls, Golf, etc.) Colleges Against Cancer Patient support programs Determination (Reach to Recovery, Road to Recovery, Man to Man, I Can Cope, etc.) Other:

6 Please list any other community organizations you belong to or participate: Legislative Experience: Legislative experience is not necessary to become a Legislative Ambassador but if you have any prior legislative experience please share below. Do you have a relationship with any federal, state or local elected officials? If yes, please list with whom and describe your relationship: Are you now or have you ever been an elected official? If yes, please explain. Which of these advocacy programs or activities have you been actively involved in? California State Legislative Day Other Advocacy activities Federal Lobby Day Meeting with an elected official I am interested in serving in the following roles: In-District Meeting Manager Media advocacy spokesperson Ambassador Leadership Role References: Please list at least two American Cancer Society staff and/or volunteers with whom you have worked, including their phone number and/or address: Name: Name: Name: Phone/ Phone/ Phone/ California Ambassador Agreement I agree to become a California Volunteer Legislative Ambassador for the American Cancer Society Cancer Action Network and will fulfill the required volunteer responsibilities as outlined in the attached Legislative Ambassador Description. I understand that I may withdraw my participation at any time as a Volunteer Legislative Ambassador by contacting the American Cancer Society Cancer Action Network California Office. Signature: Date: Please return completed application to: American Cancer Society Cancer Action Network, Inc. California Office Attn: Legislative Ambassador Application th Street, Suite 2200, Sacramento, CA fax: