"I just returned home after a fabulous day (cool, rain, windy) walking with thousands for the Komen Madison Race for the Cure®. Upon opening my goodie bag, given to all participants, I truly felt a necessity to write. Thank you for all the important information - the very contagious smiles - the darling pink ribbon angel which I shall proudly wear - but thank you especially for caring!"

Helping You > Resource Information Form

Resource Information Form

For support groups, treatment, products and services specific for women affected by breast cancer. Please fill out the following form if you know a resource in our community that you would like added to our website.)

*Resource or program name:
Type of resource:
Resource description:
Who is eligible for this resource?
Organization (or individual) providing this resource:
Organization phone:
Organization website:
*Organization email address:
Organization mailing address:
City:
State/Zip:
If applicable, list meeting times and details:

For support groups or other programs with meeting places other than the organization address, where do the meetings take place?

Support Group Location:
City:
State/Zip:
Is this a free resource? Yes No
If no, What is the cost?
Who is the best person for the public to contact about this resource?
Contact's phone:
Contact's email:
Is this the same person the Komen Madison Affiliate should contact about this resource? If not, whom should we contact?
Contact's phone:
Contact's email:
Please share any other useful information about this resource:

For books, booklets or other publications, please include the following information:

Resource publication date:
Name of author(s) as listed in the resource:
Can this publication be purchased in bookstores? Yes No
Where else can this publication be found?
Are you the provider of this resource? Yes No
Your name:
Your phone number:
Your email address: