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 95814-2742
tel 916.448.0500 / fax 916.447.6931
GET INVOLVED IN THE LEGISLATIVE FIGHT AGAINST CANCER
Become A California Volunteer Legislative Ambassador!
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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
emails, letters, faxes, make phone calls and personal visits. You can also
encourage others to get involved with you to help strengthen our grassroots
movement.
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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.
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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
([email protected]) or Ann Goure’, Director of Grassroots Advocacy at
ann.goure’@cancer.org or 916-504-2472.
You can do this even if you have no prior legislative experience!
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
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Respond to and share ACS CAN Legislative Action Alerts
Visit the ACS CAN website (www.acscan.org) 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.
2012 CALIFORNIA LEGISLATIVE AMBASSADOR APPLICATION
Personal Information (please print):
First & Last Name:
Employer:
Job Title:
Home/Physical Address:
City:
Day Phone: (
State: CA
)
Preferred Phone: (
Zip:
Evening Phone: (
)
Cell Phone: (
)
)
Email address:
Fax: (
)
An email 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 www.acscan.org 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:
 Health professional/researcher
)
 Caregiver
 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:
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 email address:
Name:
Phone/email:
Name:
Phone/email:
Name:
Phone/email:
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:
Please return completed application to:
American Cancer Society Cancer Action Network, Inc.
California Office
Attn: Legislative Ambassador Application
980 9th Street, Suite 2200, Sacramento, CA 95814-2742
916.448.0500 • fax: 916.447.6931
Date: