Host a Party Form

Fill out the form below and a member of our CanCan team will contact you to coordinate a free ovarian and breast health education party.

Name of organization:

Brief description of organization:

First & last name of host:

Date of workshop:

Time of workshop:

Address of workshop:

City, State & Zip code of workshop:

Location of workshop (please include instructions for entrance into building and room location):

Parking instructions:

Type of gathering: (ie: book club, co-workers, sorority, etc):

Expected number of attendees:

Age range of attendees (check all that apply):

18-25 years26-39 years40-55 years55+ years

In attendance (check all that apply):

WomenMenCo-ed

Your phone number (number we can reach you at the time of the workshop):

Your email: