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Understanding Cancer

National Spotlight

Financial Resources —Did you know that there are many financial resources that can help people living with breast cancer? Find out more

Rally for the Cure — Golf, tennis, dinner events and so much more...

Go Passionately Pink to help save lives! — Just wear pink, have fun and raise money to fight breast cancer. Be inspired by the multitude of ideas right here, or think of your own. There are so many creative ways to have fun and fight breast cancer.

Local Resources

Our Community Need

Survivor's Circle

Educational Materials

Health Fairs

Presentations

Health Fairs

We participate in local and regional Health Fairs and Employee Benefit Fairs year round. If you would like us to participate in your Fair by providing breast health materials and volunteers, please fill out the survey below at least 3 weeks in advance. For questions email destiny@komencentraltexas.org.

Please complete the fields below:

Name:

First Required	Last Required

Email: Required

Phone Number: Required

*2.

Question - Required - Organization/Company Requesting materials/volunteers:

*3.

Question - Required - Address of Company/Organization requesting materials/volunteers:

(Maximum response 255 chars, approx. 5 rows of text)

*4.

Question - Required - Are you the point of contact for this event?

Question - Not Required - If you are not the point of contact, please provide that person's name, phone number and email:

*6.

Question - Required - Date of your event:

Month

Day

Year

*7.

Question - Required - Age Range of Attendees:

*8.

Question - Required - Number of Attendees:

*9.

Question - Required - Language Preferred: English
Spanish
Both
Other

10.

Question - Not Required - Please check all of the activities that you plan to include in your event. All the below will be your responsibility unless you request for our Affiliate to provide one of the items below.
Please make at least 1 selection from the choices below.

	Guest speaker (We recommend using a survivor)
	Special tribute to survivors and co-survivors
	Special tribute to those who have lost their lives to breast cancer
	Education table
	Bulletin board featuring educational material and other information
	Pink treats, i.e. pink cupcakes, punch, flowers, ribbons
	Members will wear pink
	On-site breast cancer screening
	Other (please describe):

Please provide the number of packets for women ages 20-34 in the following categories:

11.

Question - Not Required - African-American

12.

Question - Not Required - Asian/Pacific Islander

13.

Question - Not Required - Caucasian

14.

Question - Not Required - Hispanic/Latina

15.

Question - Not Required - Other (please specify)

Please provide the number of packets for women ages 35 and older in the following categories:

16.

Question - Not Required - African-American

17.

Question - Not Required - Asian/Pacific Islander

18.

Question - Not Required - Caucasian

19.

Question - Not Required - Hispanic/Latina

20.

Question - Not Required - Other (please specify)

Central Texas Affiliate of Susan G. Komen for the Cure®
3000 Herring Ave. 4E Waco, TX 76708 · Phone: 254-753-3037 · Fax: 254-753-3397 · Email: cta@komencentraltexas.org

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