First Name *

Last Name *

Your organization's name (i.e. "American Medical Association" -- please spell out full name of org): *

Email address *

Role at my organization: *

Member

Staff

Your Twitter handle (or if staff, your org's Twitter handle): *

I give the AMA permission to include my Twitter handle on a public Twitter list of #MaskUp Social Media Champions: *

yes

Your Instagram handle (or if staff, your org's Instagram handle): *

I pledge my participation in this critically important public health campaign, to the best of my ability: *

yes

I agree to share these assets with my own social media networks and with my colleagues, compelling them to participate in the #MaskUp campaign: *

yes

I give the AMA social media team permission to email me, as a #MaskUp social media champion, with updates and campaign assets: *

yes