PFF Ambassador Request Form

Thank you for requesting a PFF Ambassador to attend your event! PFF Ambassadors are available to speak at PFF Care Center events, PF support groups, fundraising events for the PFF, and other disease awareness programs. Ambassadors share their experience, promote disease awareness, and provide up-to-date information.

Over the past four years, the Pulmonary Fibrosis Foundation (PFF) has increased the number of virtual opportunities for PFF Ambassadors to attend. With the expansion of virtual events, the PFF Ambassador program has been able to accommodate the health and location of more individuals which has allowed the PFF to showcase more perspectives of the pulmonary fibrosis community. The PFF understands the importance of in-person engagements; however, due to the current constraints of the PFF Ambassador program, PFF Ambassadors will not be able to attend in-person events unless travel expenses are covered by the event organizer requesting their appearance beginning July 2024.

Please fill out the below information so we can process your request. If you have any questions about requesting a PFF Ambassador, please call the PFF Help Center at 844.TalkPFF (844.825.5733) toll free or email help@pulmonaryfibrosis.org.

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* 1. Your Contact Information

Name *

Company (if applicable)

Email Address *

Phone Number

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* 2. Is this a virtual event?

Yes

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* 3. Event Information

Event Title *

Event Date *

Event Times *

Address of Event

Address 2

City/Town of Event *

State of Event *

Zip / Postal Code of Event

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* 4. Type of Event

PFF Care Center Network event

PF support group

Fundraising event for the PFF

Other disease awareness program

Other (please specify)

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* 5. The PFF Ambassador Program has speakers that are patients, caregivers and lung transplant recipients that share the story of their journey with PF. There are also healthcare professional Ambassadors who provide disease education through the "Understanding PF" slide deck. Please indicate the type of Ambassador you'd like for your event. You can indicate more than one.

Patient

Caregiver

Lung transplant recipient

Healthcare Professional

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* 6. Please provide a brief description of the event and any other information that you think will be helpful.

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* 7. Approximately how long will the Ambassador have to speak? Please indicate if they need to leave part of this time to answer questions or if there will be extra time allotted to answer questions.

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* 8. Who is the primary audience for this event?

Patients

Caregivers

Healthcare Professionals

Family and Friends

General Public

Other (please specify)