Become a Cure Leader for I AM THE CURE ® today!

Please be sure to include the following information:

Name

Group or Individual

Group Name (if applicable)

Group Type: corporate/government, small business, family and friends, or schools/education

Number of People in Group

Main Contact: Phone, Fax, Email, and Mailing Address

Best time to reach you: Morning, Day or Evening

Emergency Contact Information

Are you are any group members breast cancer curvivors: Yes/No

If so, what are their names

Any special skills/training/qualifications

Why are you interested in I AM THE CURE®

You may email, mail, or fax your I AM THE CURE® registration to:

Susan G. Komen SF Bay Area Affiliate ~ 150 Post Street, Suite 755, San Francisco, CA 94108 Tel: 415-397-8812 ~ Fax: 415-397-8817 ~ Email: raceinfo@komensf.org ~ www.komensf.org