Rally Registration
AMBASSADOR'S INFORMATION
First
Last
Address
City
State
Please select...
AA
AE
Alabama
Alaska
AP
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP
Phone
Email
Instagram ID
Twitter Handle
Facebook URL
EVENT INFORMATION
Club/Group Name
Event Date (mm/dd/yyyy)
EVENT TYPE (please select all that apply)
Dining
Golf
Tennis
Other
Please Specify
HAS YOUR GROUP OR CLUB HOSTED A RALLY BEFORE?
Yes
No
If yes, please enter your last event ID Number (if known)
Venue Name
Venue Address
Venue City
Venue State
Please select...
AA
AE
Alabama
Alaska
AP
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Venue ZIP
Where would you like your donation to go?
Please select...
To help local communities support programs such as education, screen and treatment programs.
To help nationwide breast cancer programs such as research and treatment assistance.
Note: If you select your local communities, a minimum of 25% of your donation will be distributed to Komen National to support breast cancer research.
RALLY REMINDER (mm/dd/yyyy)
YES, I would like to receive emails and other communications from Susan G. Komen.
I accept the Rally for the Cure
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.
By registering your event, you agree to Susan G. Komen's
Terms of Use
, including the terms for posted content, and
Privacy Policy
.
Contact Information