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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
















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)













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







Community Grant Directory



IL Research Grants Fact Sheet 



Komen Chicago Volunteer Opportunities



About Susan G. Komen Chicago 


   Please leave this field empty