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Educational Materials Request Form

To ensure you receive your materials in a timely manner, please make your request 30 days before your scheduled event.
NOTE: If you are requesting a Komen representative and/or speaker in addition to educational materials, please use the Health Fairs | Speaker Request Form only.

 

Provide your contact information.

  Contact Information

*

Name:

 

 

   

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City/State/ZIP:

 

    

 

 

 


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Question - Required - Date Materials Needed




*


  If you answered NO to the previous question, where would you like the materials shipped? (You will be contacted with shipping charges)

 

Name:

 

 

   

 

 

 

City/State/ZIP:

 

    

 

If you respond and have not already registered, you will receive periodic updates and communications from Susan G. Komen® Chicago.


 

What educational materials are you requesting?

Indicate the number of each requested, up to a total of 25 items.

 

Breast Self-Awareness Card

 


 


 


 

General Breast Health Information Brochure

 


 


 

Men Can Get Breast Cancer, Too

 


 


 

Young Women Brochure

 


 


 

Mammography Card

 


 


 

Bookmarks

 


 

Community Grant Directory

 


 

IL Research Grants Fact Sheet 

 


 

Komen Chicago Volunteer Opportunities

 


 

About Susan G. Komen Chicago 

 


   Please leave this field empty