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* 1. What is your preferred Contact Information?

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* 2. Please describe in three to four sentences your breast cancer journey as a survivor, fighter, forever fighter, or co-survivor and why you have been involved with Komen Michigan (why is Komen Michigan important to you and or the community).

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* 3. We ask that you enjoy a meal at your Applebee's from 6:00-8:00pm June 5, 2019. We will provide you with education materials to share, are you able to attend this meal at this time? Family and Friends are more than welcome to join!

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* 4. One week before the event, we ask that you check in with your Applebee's contact (provided by Komen) to ensure clear communication on details of support. Are you comfortable with this action? 

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* 5. Which location would you like to serve as an ambassador for the Apple's for the Cure Program? We have a total of 45 locations this year!! 

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* 6. Do you know anyone that would be interested in being an ambassador for Apple's for the Cure 2019? 

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* 7. Please send me your favorite picture of yourself to be featured on your restaurant table tent or below mark "same as last year". Please email them to: rburnosky@komenmichigan.org 

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