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 2017.

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 kick off luncheon in two locations, to help with travel time.Attending the kick-off luncheon 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
• Consider celebrating survivors in some way during Worship in Pink

* 1. Organization Information

* 2. How many will attend our Coordinator Training? (Columbus: August 25th, 11:30 am and August 26th, 10:00 am @ Our Affiliate office in Westerville) (Southeast Ohio: August 30th, 11:30 @ Athens Community Center)

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

* 4. Please estimate how many people will be in attendance at your Worship in Pink event. We'll include enough educational materials in your Worship in Pink kit for this number of people. Material pick-up will be September 25th - 29th, 2017 at our affiliate office in Westerville. Southeastern Ohio packages will be shipped.

* 5. Please pick an either a fan or a magnet below for your educational material that will be included in your tool-kit for your Worship in Pink event. 

* 6. 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. You only need one, but can name more than one if a few people will share the responsibility. These individuals will be responsible for picking up materials, and invited to a follow-up appreciation event after you have completed the Worship in Pink program.

* 7. 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.

* 8. Would you like a video containing survivor stories and educational content to use in your event?

* 9. Which format would you like your video to be on?

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

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

* 12. Do you have any other comments, questions, or concerns?

* 13. 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. If, so please describe.

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