On-Campus Ambassador Registration Form

Complete the form below to become a Half Your Plate on-Campus Ambassador.

First Name*
Last Name*
College / University Name
City*
Province*
Country*
Email Address*
Are You A Student Faculty or Staff at your University?*
- Student Faculty
- Staff
Area of Study*
Expected Date of Graduation*
Date Format: MM slash DD slash YYYY
Department*
Comments
Are you interested in being listed on our Half Your Plate on Campus Ambassador page?*
- Yes
- No
Would you like to receive future updates and materials?*
- Yes
- No
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.