Health Fairs

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Local Resources

Educational Materials

Health Fairs

Presentations

Health Fairs

We participate in local and regional Health Fairs and Employee Benefit Fairs year round. If you would like us to participate in your Fair by providing breast health materials and volunteers, please fill out the survey below at least 3 weeks in advance. For questions email education@komenaustin.org.

*1.

Question - Required - First and Last Name (include title, suffix, professional suffix if applicable):

*2.

Question - Required - Email:

*3.

Question - Required - Phone Number with area code:

*4.

Question - Required - Organization/Company Requesting materials/volunteers:

*5.

Question - Required - Address of Company/Organization requesting materials/volunteers:

*6.

Question - Required - Are you the point of contact for this event? Yes
No

Question - Not Required - If you are not the point of contact, please provide that person's name, phone number and email:

*8.

Question - Required - Date (1st choice). At minimum must be three weeks from today:

Month

Day

Year

Question - Not Required - Date (2nd choice):

Month

Day

Year

*10.

Question - Required - Age Range of Attendees:

*11.

Question - Required - Number of Attendees:

*12.

Question - Required - Language Preferred: English
Spanish
Both
Other

13.

Question - Not Required - Additional Information:

Austin Affiliate of Susan G. Komen for the Cure®
P.O. Box 2164, Austin, TX 78768 · Phone: 512-473-0900· Fax: 512-473-0999 · Email: info@komenaustin.org

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