Community Promotions Application

Name of Business*:

Contact Person*:

Position*:

Address*:

City*: State*: AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY AE AA AP Zip Code*:

Telephone*: Fax:

Email*:

Type of Event/Promotion*: Date Specific Event Ongoing Promotion Other

If "Other", Describe Type of Event:

Date: Time: Place*:

Number of projected attendees*:

Please list all beneficiaries of this event/promotion.*

Briefly describe how event will be promoted.*

2. Would you like us to provide our promotional material at your event?  Yes No

3.  To Celebrate Life Breast Cancer Foundation does not share its database.

By pressing submit, you agree to the above terms.