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Outreach Request

 

To request a representative, educational materials or breast health presentation at your organization, event or health fair, please fill out this form at least 3 weeks in advance of your proposed date. We will try to accommodate all requests, however fulfillment of the request is not guaranteed and is based on availability. Please contact Jacquaya Reel as soon as you are able if any of the information below changes.

Breast health presentations are conducted by the community outreach team and volunteers. These volunteers are Komen Education Ambassadors who are trained, skilled and enthusiastic speakers who are ready to spread the word about the fight against breast cancer through free breast health presentations in English and Spanish. Please note that only requests within our 13-county service area can be considered.  Also as following our policy, we are unable to participate in events which charge a fee for non-profit participation.

For more information or questions please contact: 

Mary Hamrick (Community Outreach Coordinator)

By Phone: 704-817-4086 or By Email: m.hamrick@Komencharlotte.org

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Question - Required - Today's Date




2. Contact Information:

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Name:

 

 

   

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City/State/ZIP:

 

    

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Date of Birth:

 


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Question - Required - Event Date (At minimum must be three weeks from today)




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

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15. Language preferred
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Question - Required - Support Requests (While our goal is to fulfill all requests, volunteer and staff availability on event dates and location will be considered)

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Health Fair Requests:

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Speaker Request:

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