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Worship in Pink 2019 Registration

 

Worship in Pink

October 2019

Worship in Pink

To participate in the Worship in Pink (WIP) program, please submit this registration form.  Because educational resources are available at a first come, first serve basis, it is highly recommended that your WIP program is registered by September 20, 2019. For questions, please call Community Engagement Manager, Elizabeth Zimmerman, at (540) 400-8222 x3.

"The WIP Coordinator will be the MAIN point of contact for questions and updates about each organization’s WIP registration, including educational packet pick-up and speaker requests. Please ensure that the WIP Coordinator is able to respond to emails and phone calls about WIP registration in a timely manner".

 

 


 

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Question - Required - Please note the preferred method of communication for each WIP coordinator:
Please make between 1 and 3 selections from the choices below.

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

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**The educational packets come in packs of 50 and are limited. Packets will be dispersed on a first-come-first-served basis with a maximum of 3 packets (enough materials for 150 people) per registered organization. Please return any remaining education packet material to Susan G. Komen Virginia Blue Ridge after WIP.**

* Ethnic Breakdown of Recipients:
(Select one of the available choices or enter a different value.)



* Language Breakdown of Recipients:
(Select one of the available choices or enter a different value.)



 

** Information can be provided for different ethnic groups and in different languages-please contact the office to learn more**

 

 


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Question - Required - Planned Educational Activity (Please check at least one):
Please make between 1 and 4 selections from the choices below.

 

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

 
Question - Not Required - Other Activities Planned (Check all that apply):

 

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

 


 

*Please note: Susan G. Komen Virginia Blue Ridge recommends each faith-based organization find a congregation member to serve as a WIP speaker.   The Virginia Blue Ridge Affiliate has trained volunteer breast health awareness speakers; however, speakers are limited and will be scheduled based on availability.

If you would like to speak in further detail about WIP education activities, please contact Community Engagement Manager, Elizabeth Zimmerman at ezimmerman@komenvablueridge.org or (540) 400-8222 x3.

 

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