Worship in Pink Weekend 2011:
October 28th - October 30th

Thank you for registering for our 6th Annual Worship in Pink Weekend, October 28th, 29th, and 30th! Please complete the registration form in its entirety. For questions, email lmurphy@komenatlanta.org or call 404-459-8700.

(*) - Required
Name of religious organization (*)
Address of organization
City
State
Zip
Phone (*)
County	Choose one... Cherokee Clayton Cobb DeKalb Fayette Forsyth Fulton Gwinnett Henry Rockdale Other
Web site
WIP weekend coordinator name (*)
Role in Organization (if applicable)
Coordinator email(*)
Will this be the organization's first time participating in WIP? (choose) Yes No
Would your organization be willing to participate in a pilot evaluation of the effectiveness of WIP (organizations in Rockdale, Fulton and Dekalb counties ONLY)? (choose) Yes No
Pick-Up Location: Buckhead/Sandy Springs Greater Atlanta Affiliate of Susan G Komen for the Cure 4840 Roswell Road Atlanta, GA 30342
Number of members in organization
Number of Packets Requested: (1,000 maximum)
Ethnic breakdown of packet recipients by percentages Information can be provided in many different languages - please contact the Komen Atlanta office for more information. African-American Hispanic/Latino Caucasian Asian/Pacific Islander Other (please specify):

Be sure to check out the Worship in Pink Facebook page!