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All WASH-RAG Ambassadors must be Rotarians and have, or obtain upon renewal, the five year level of membership in the WASH Rotary Action Group. If necessary, please confirm your membership status by contacting us at Membership Confirmation.

*** Click here to begin your application

* First Name
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* Last Name
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* Phone Number
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* E-mail Address
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* Address 1
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Address 2
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* City
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* State or Province
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Postal Code
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* Country
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* What is the name of your Rotary Club?
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* What is the number of your Rotary District
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* In what District do you wish to serve as Ambassador?
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* What would be your goals and objectives if you were appointed as an Ambassador?
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* What would you do to achieve these goals?
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* Are you able to facilitate the translation of communications from WASH-RAG from English into the primary language(s) of the Rotarians in your Ambassadorial area?
* By typing your name in this box, you are confirming that you are a WASH-RAG member in good standing and will pursue the objectives outlined in this form to the best of your abilities.
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