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2012 Paint it Pink - Registration Form

1. Contact Information:

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Name:

 

 

   

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*2.  


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*4.

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

*5.

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

6.
Question - Not Required - Please promote my involvement in the Paint it Pink campaign thru the following:

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What's my next step?

Our staff will review your form and contact you to support your promotion or event. You can download the Paint it Pink Toolkit or create your own Fundraising Page to learn more.

Please send your Paint it Pink contribution with a Donation Reply form to the Puget Sound Affiliate of Susan G. Komen for the Cure on or before November 30, 2012.

Susan G. KomenŽ Puget Sound
Attn: Paint Puget Sound Pink
112 Fifth Avenue N
Seattle, WA 98109

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