Walk Captain Application

Thank you for your interest in becoming a FFBWW Walk Captain and leading an experience within your community! Throughout the year a number of walking excursions are hosted as part of the FFBWW Walking Collective to support a healthy, active lifestyle for Black women and their families and communities. Please take the next 5 - 7 minutes to complete the application below and a representative will reach out via email with next steps.

Primary Email Address

Are you currently a FFBWW Wellness Ambassador?

Please note: Only current Wellness Ambassadors are eligible to apply. Visit ffbww.org/ambassadors to get started!

Yes. Please proceed with this application.
No. Please stop here and visit ffbww.org/ambassadors to apply.

First Name

Last Name

Date of Birth

Street Address

City

State

Zip Code

County

Cell phone number

Name of Emergency Contact

Relationship to Emergency Contact

Cell phone number for Emergency Contact

Enter the proposed START DATE for your walk:

Enter the proposed START TIME of your walks:

Enter the proposed END TIME:

How often would you like to consistently host your walk:

Weekly
Bi-weekly
Monthly

Enter the proposed location and address of your walk:

Do you have a co-captain who will be leading the walks with you, or in your absence?

Yes
No
Not yet

By checking each box below, I understand and will commit to the following responsibilities:

Today's Date

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