AAIC Celebrity Ambassador Form Please complete and submit the form below to register as an AAIC Celebrity Ambassador. Please film a short video, around one minute or less stating: Who you are and a brief description of your background. Your views on the impact of the Ice epidemic. A firm statement to our youth - "Don't touch Ice - NOT EVEN ONCE" A statement encouraging all Australians to join you in the AAIC Army to help us Put the Freeze on Ice. Once you complete and send this form you will receive a confirmation email with the video upload instructions. Contact Name Contact Phone Email Address State or Territory Queensland North Queensland New South Wales Victoria South Australia Australian Capital Territory Tasmania Western Australia Northern Territory National Post Code Brief description of your background Are you available to speak to the media as an AAIC Ambassador to help promote the AAIC Army launch? Yes No Are you available to speak to the media as an AAIC Ambassador from time to time as arranged by AAIC's media division? Yes No Do you give your authority for AAIC to post your video on the Internet? Yes No Are you available to speak at an AAIC corporate function or other event? Yes No What fee would you charge to appear at an AAIC function in the region that you live? What fee would you charge to appear at an AAIC function in a regional community requiring an overnight stay? How did you hear about AAIC? submit Please turn on javascript to submit your data. Thank you!
