Host an Event for the PBCC - PA Breast Cancer Coalition

Coordinator Name*

Coordinator address*

Street Address Address Line 2 City State ZIP Code

Email address*

Phone number*

Event name*

Event location*

Street Address Address Line 2 City State ZIP Code

Event date*

If tentative, please designate in the event description.

Event start time

: HH

MM

Event description*

Event website or social media page

Is this a public event?*

Yes
No

Is this an annual event?*

Yes
No

Estimated attendance

Upload a photo for the event

Drop files here or

Upload other files for the event (max. 15MB)

Will you need PBCC branded materials for your event?*

Yes
No

Branded materials include print materials and small items such as wristbands or pens. Quantities of material are based on availability at the time we receive your request. If you would like to request additional quantities of any PBCC materials, please email Brittani@PABreastCancer.org or call 717-769-2301.

Pens

Wristbands

Nail files

Hand sanitizers

Lip balms

Wrist strap keyholders

I would like copies of the following PBCC branded literature: (check all that apply)*

N/A - no literature needed
PBCC general brochure
Mammogram and patient advocacy card
Breast self-exam guide (English)
Breast self-exam guide (Spanish)
Screening guidelines (in English and Spanish)
Friends Like Me care package flyer
Frontline newsletter

to learn more about PBCC Branded Materials.

I will need a press release for my event*

Yes
No

I will need an acknowledgement letter confirming the PBCC's endorsement of this event.*

Yes
No

I agree to the Guidelines for Grassroots Partners*

I have read and agree to the Guidelines for Grassroots Partners

to read our Guidelines for Grassroots Partners.

I understand that, as a Grassroots Partner, funds raised at my event will benefit the PA Breast Cancer Coalition.*

Yes, I'm ready to get started!