VIPink

A community of bold leaders. A commitment to a world without breast cancer.

Nominate an Ambassador

You can nominate a leader in your community - or nominate yourself - by completing the information below. A member of our team will follow-up with your nominee soon to collect additional details.

VIPink Ambassadors Commit to:

Wearing pink throughout their campaign to raise awareness
Activating their networks to fundraise for Susan G. Komen
Raising a minimum of $5,000 through their campaign efforts

Your Information

Field Is Required First Name (Maximum response 255 chars, approx. 5 rows of text)

Field Is Required Last Name (Maximum response 255 chars, approx. 5 rows of text)

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

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

Field Is Required Email (Maximum response 255 chars, approx. 5 rows of text)

Field Is Required Phone (Maximum response 255 chars, approx. 5 rows of text)

Field Is Required Relationship to Nominee

Field Is Required Nominee's First Name (Maximum response 255 chars, approx. 5 rows of text)

Field Is Required Nominee's Last Name (Maximum response 255 chars, approx. 5 rows of text)

Nominee's Company (optional) (Maximum response 255 chars, approx. 5 rows of text)

Nominee's Title (optional) (Maximum response 255 chars, approx. 5 rows of text)

Field Is Required Nominee's Email (Maximum response 255 chars, approx. 5 rows of text)

Field Is Required Nominee's Phone (Maximum response 255 chars, approx. 5 rows of text)

Field Is Required Nominee's City (Maximum response 255 chars, approx. 5 rows of text)

Field Is Required Nominee's State

Field Is Required What makes this person a great VIPink Ambassador candidate? (Maximum response 255 chars, approx. 5 rows of text)

Field Is Required Is the nominee aware they are being nominated?

Please make sure all required fields are filled out appropriately.