Registration ends August 10th. Please contact laurenbeitel@komencolumbus.org with any questions!

If you are the coordinator for multiple congregations please fill out a separate registration for each! Thank you! 

We are thrilled that you are joining us to raise awareness of breast cancer and of the importance of early detection in saving lives, by participating in Worship in Pink. Please complete this form to register and commit to participate in Worship in Pink 2018.

Your organization must be located in the Komen Columbus service area (central and southeastern Ohio). We have been excited to grow Worship in Pink to include more and more counties. We will hold a breakfast kick off at our affiliate office in Westerville, Ohio on September 7th at 8AM. If you would like to RSVP for this event please make sure to fill out the last question of the survey. Attending the kick-off is not required to participate, just a chance to learn more and prepare!

By registering, you are making a commitment to:
• Promote breast cancer awareness and screening in your congregation through Worship in Pink outreach and education activities
• Act as a Worship in Pink Coordinator to represent your congregation and be the main contact- or appoint one
• Work with your pastor or leadership to schedule a date for your Worship in Pink event
• Utilize the materials provided by Susan G. Komen Columbus by disseminating them to your congregation and connecting them with a local patient navigator if they ask. 
• Consider celebrating survivors in some way during Worship in Pink
• Send any donations or funds raised by your event to Komen Columbus to support our programs serving the community
Organization Information

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* 1. Organization Information

Please identify at least one Worship in Pink Coordinator. The Ambassador will serve as the main contact and planner for the program for your organization. This can be clergy, health ministers or volunteers. 

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* 2. Please identify at least one Worship in Pink Coordinator. The Ambassador will serve as the main contact and planner for the program for your organization. This can be clergy, health ministers or volunteers. 

Please pick a weekend for your Worship in Pink event and submit below:

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* 3. Please pick a weekend for your Worship in Pink event and submit below:

Please estimate how many people will be in attendance at your Worship in Pink event. 

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* 4. Please estimate how many people will be in attendance at your Worship in Pink event. 

How many breast cancer survivors do you think will participate in your event? We will provide a small gift for each survivor. We'll also provide a certificate template you can use to honor each survivor.

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* 5. How many breast cancer survivors do you think will participate in your event? We will provide a small gift for each survivor. We'll also provide a certificate template you can use to honor each survivor.

Please describe the majority demographic of your organization.

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* 6. Please describe the majority demographic of your organization.

How did you hear about Worship in Pink?

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* 7. How did you hear about Worship in Pink?

Does your church or organization participate in any other Komen Columbus activities? If you had a team for the Race for the Cure please tell us your team name below.

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* 8. Does your church or organization participate in any other Komen Columbus activities? If you had a team for the Race for the Cure please tell us your team name below.

This year we are adding a fundraising component to Worship in Pink. Your fundraising has the power to make a true impact. 


Please create a fundraising goal for your church/congregation. The minimum amount is $50 but we encourage you create a challenging goal to help continue the fight of breast cancer and saving lives. Please list the goal that your church/congregation has created below. 


Feel free to reach out if you have questions on fundraising. Thanks in advance for all that you do!

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* 9. This year we are adding a fundraising component to Worship in Pink. Your fundraising has the power to make a true impact. 


Please create a fundraising goal for your church/congregation. The minimum amount is $50 but we encourage you create a challenging goal to help continue the fight of breast cancer and saving lives. Please list the goal that your church/congregation has created below. 


Feel free to reach out if you have questions on fundraising. Thanks in advance for all that you do!

If you would like to attend our Breakfast Kick-Off for Worship in Pink, please fill out the information below.  

Date: Friday, September 7th, 2018 
Time: 8AM
Location: Komen Columbus, 929 Eastwind Drive, Suite 211, Westerville OH 43081.

Fill out the following information to RSVP for Breakfast Kickoff

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* 10. If you would like to attend our Breakfast Kick-Off for Worship in Pink, please fill out the information below.  

Date: Friday, September 7th, 2018 
Time: 8AM
Location: Komen Columbus, 929 Eastwind Drive, Suite 211, Westerville OH 43081.

Fill out the following information to RSVP for Breakfast Kickoff

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