APPLICATION FOR HONORARY AMBASSADOR

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FULL NAME

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STREET ADDRESS

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CITY, STATE, COUNTRY, POSTAL CODE

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TELEPHONE, FAX, AND EMAIL

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SEX                  EYE COLOR                  HAIR COLOR

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HEIGHT (FT/M)          WEIGHT (LB/K)          DISTINGUISHING MARKS

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CITY, STATE, AND COUNTRY ASSIGNED TO HONORARY AMBASSADOR

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ADDITIONAL TITLES

OFFICE OF THE SECRETARY GENERAL

AFFIDAVIT OF

HONORARY AMBASSADOR

THE UNDERSIGNED SOLEMNLY SWEARS
THAT THEY HAVE NEVER BEEN
CONVICTED OF A SERIOUS CRIME
INVOLVING LIFE OR PROPERTY, AND
THAT THEY ARE OF GOOD CHARACTER:

SWORN AND SUBSCRIBED TO:








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